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Yang Z, Li Y, Huang M, Li X, Fan X, Yan C, Meng Z, Liao B, Hamdani N, El-Battrawy I, Yang X, Zhou X, Akin I. Small conductance calcium-activated potassium channel contributes to stress induced endothelial dysfunctions. Microvasc Res 2024; 155:104699. [PMID: 38901735 DOI: 10.1016/j.mvr.2024.104699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/26/2024] [Accepted: 06/02/2024] [Indexed: 06/22/2024]
Abstract
Patients with Takotsubo syndrome displayed endothelial dysfunction, but underlying mechanisms have not been fully clarified. This study aimed to explore molecular signalling responsible for catecholamine excess induced endothelial dysfunction. Human cardiac microvascular endothelial cells were challenged by epinephrine to mimic catecholamine excess. Patch clamp, FACS, ELISA, PCR, and immunostaining were employed for the study. Epinephrine (Epi) enhanced small conductance calcium-activated potassium channel current (ISK1-3) through activating α1 adrenoceptor. Phenylephrine enhanced edothelin-1 (ET-1) and reactive oxygen species (ROS) production, and the effects involved contribution of ISK1-3. H2O2 enhanced ISK1-3 and ET-1 production. Enhancing ISK1-3 caused a hyperpolarization, which increases ROS and ET-1 production. BAPTA partially reduced phenylephrine-induced enhancement of ET-1 and ROS, suggesting that α1 receptor activation can enhance ROS/ET-1 generation in both calcium-dependent and calcium-independent ways. The study demonstrates that high concentration catecholamine can activate SK1-3 channels through α1 receptor-ROS signalling and increase ET-1 production, facilitating vasoconstriction.
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Affiliation(s)
- Zhen Yang
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim (UMM), Heidelberg University, 68167 Mannheim, Germany; Department of Ophthalmology, Affiliated Hospital of North Sichuan Medical College, 637000 Nanchong, Sichuan, China
| | - Yingrui Li
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim (UMM), Heidelberg University, 68167 Mannheim, Germany
| | - Mengying Huang
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim (UMM), Heidelberg University, 68167 Mannheim, Germany
| | - Xin Li
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim (UMM), Heidelberg University, 68167 Mannheim, Germany
| | - Xuehui Fan
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim (UMM), Heidelberg University, 68167 Mannheim, Germany
| | - Chen Yan
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim (UMM), Heidelberg University, 68167 Mannheim, Germany
| | - Zenghui Meng
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim (UMM), Heidelberg University, 68167 Mannheim, Germany
| | - Bin Liao
- Department of Cardiac Macrovascular Surgery, Affiliated Hospital of Southwest Medical University, 646000, Sichuan, China
| | - Nazha Hamdani
- Department of Molecular and Experimental Cardiology, Institut für Forschung und Lehre (IFL), Ruhr-University Bochum, Bochum, Germany
| | - Ibrahim El-Battrawy
- Department of Cardiology and Angiology, Ruhr University, Bochum, Germany; Institut für Forschung und Lehre (IFL), Department of Molecular and Experimental Cardiology, Ruhr-University Bochum, Bochum, Germany
| | - Xiaoli Yang
- Department of Ophthalmology, Affiliated Hospital of North Sichuan Medical College, 637000 Nanchong, Sichuan, China.
| | - Xiaobo Zhou
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim (UMM), Heidelberg University, 68167 Mannheim, Germany; European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, and Centre for Cardiovascular Acute Medicine Mannheim (ZKAM), Medical Centre Mannheim, Heidelberg University, Germany; Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, 646000, Sichuan, China.
| | - Ibrahim Akin
- First Department of Medicine, Medical Faculty Mannheim, University Medical Centre Mannheim (UMM), Heidelberg University, 68167 Mannheim, Germany; European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, and Centre for Cardiovascular Acute Medicine Mannheim (ZKAM), Medical Centre Mannheim, Heidelberg University, Germany
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Rallidis LS, Papathanasiou KA, Kosmas N, Iordanidis D, Rallidis SL, Simitsis P. Is premorbid stress assessed by hair cortisol concentration linked to Takotsubo syndrome? Results from a pilot study. Int J Cardiol 2024; 410:132241. [PMID: 38844095 DOI: 10.1016/j.ijcard.2024.132241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/26/2024] [Accepted: 06/03/2024] [Indexed: 06/17/2024]
Abstract
INTRODUCTION The pathophysiology of Takotsubo syndrome (TTS) is not completely understood and the role of chronic stress is among the main mechanistic links. The aim of this study was to explore whether accumulating hair cortisol concentration (HCC), a novel biomarker of chronic stress, is associated with the occurrence of TTS. METHODS A consecutive series of 18 TTS patients and 36 age and sex matched healthy controls were included in our analysis. Hair samples were collected from participants'' vertex. The proximal 2.5 cm of hair was cut in equal parts of 0.5 cm, reflecting mean cortisol levels in time intervals of 0-15, 15-30, 30-45, 45-60 and 60-75 days prior to hair collection. RESULTS HCC was higher in TTS group compared to controls at any time point and increased over time starting from 75 days prior to the event. The rate of HCC increase was significantly higher in TTS patients versus controls (beta of interaction = 0.48; 95%CI: 0.36-0.60; p < 0.001). CONCLUSIONS The steadily increasing trend of HCC in TTS patients suggests that the additive effect of multiple stressful events over several weeks prior TTS onset may disrupt cortisol homeostasis and play a role in TTS pathophysiology.
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Affiliation(s)
- Loukianos S Rallidis
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece.
| | - Konstantinos A Papathanasiou
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece
| | - Nikolaos Kosmas
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece
| | - Dimitrios Iordanidis
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece
| | | | - Panagiotis Simitsis
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece
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Strohleit D, Aweimer A, Akin I, Hamdani N, El-Battrawy I. Symphony of surprises: Unveiling organ interactions in Takotsubo Syndrome. Int J Cardiol 2024; 408:132148. [PMID: 38735440 DOI: 10.1016/j.ijcard.2024.132148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 05/14/2024]
Affiliation(s)
- Daniel Strohleit
- Department for cardiology and angiology, BG university hospital Bergmannsheil, Ruhr University Bochum.
| | - Assem Aweimer
- Department for cardiology and angiology, BG university hospital Bergmannsheil, Ruhr University Bochum
| | - Ibrahim Akin
- Medical University Mannheim, Medical Faculty, Mannheim University, Heidelberg, Germany
| | - Nazha Hamdani
- Department of Cellular and Translational Physiology, Institute of Physiology, Ruhr University Bochum, 44801 Bochum, Germany; Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, 44801 Bochum, Germany; Department of Physiology, Cardiovascular Research Institute, Maastricht University, 6229 ER Maastricht, the Netherlands; HCEMM-SU Cardiovascular Comorbidities Research Group, Department of Pharmacology and Pharmacotherapy, Semmelweis University, 1089 Budapest, Hungary; Department of Cardiology, St. Josef-Hospital, UK RUB, Ruhr University Bochum, 44791 Bochum, Germany
| | - Ibrahim El-Battrawy
- Department of Cellular and Translational Physiology, Institute of Physiology, Ruhr University Bochum, 44801 Bochum, Germany; Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, 44801 Bochum, Germany; Department of Cardiology, St. Josef-Hospital, UK RUB, Ruhr University Bochum, 44791 Bochum, Germany.
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Soundarrajan D, Singh R, Subramaniam M, Dhanasekararaja P, Rajkumar N, Rajasekaran S. Takotsubo syndrome after bilateral simultaneous total knee arthroplasty - A case report. J Orthop 2024; 54:1-4. [PMID: 38496261 PMCID: PMC10943950 DOI: 10.1016/j.jor.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/03/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction Cardiac complications represents a major cause of morbidity and mortality especially after bilateral simultaneous total knee arthroplasty (BS-TKA). Takotsubo syndrome after BS-TKA has not been described in the literature. Case presentation A 60 years-old women underwent BS- TKA and she suddenly developed bradycardia and hypotension after second knee wound closure. The electrocardiography revealed ST elevation and echocardiography showed apical hypokinesia of left ventricle. Coronary angiography revealed normal epicardial coronaries and a provisional diagnosis of Takotsubo cardiomyopathy was made. Serial ECGs revealed resolution of ST elevation and normal LV function within 5 days. On one-year follow up, she was able to do all her normal activities, and 12-lead electrocardiography were back to normal. Conclusion Cardiac complications represents a major cause of morbidity and mortality especially after BS-TKA. Surgeons must be vigilant in the postoperative period for any likely precipitating factors of stress induced cardiomyopathy. Takotsubo syndrome should be considered as a differential diagnosis with features of acute coronary syndrome in elderly post-menopausal patients.
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Affiliation(s)
| | - Rithika Singh
- Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641 043, India
| | - Muthiah Subramaniam
- Consultant Cardiologist, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641 043, India
| | | | - Natesan Rajkumar
- Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641 043, India
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Krouma M, Aboudou Soilihi A, Pech-Gourg G, Arnaud S, Fadoua EL, Caruselli M, Scavarda D. Takotsubo syndrome linked to paroxysmal sympathetic hyperactivity as a postoperative complication after brain tumor removal: a case report and literature review. Childs Nerv Syst 2024; 40:2573-2579. [PMID: 38383868 DOI: 10.1007/s00381-024-06316-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/06/2024] [Indexed: 02/23/2024]
Abstract
Paroxysmal sympathetic hyperactivity (PSH) is a relatively common syndrome typically observed following traumatic brain injury (TBI). It manifests through a combination of non-specific symptoms that collectively define its presentation. Linked to sympathetic hyperactivity, takotsubo syndrome is a cardiomyopathy marked by left ventricular dysfunction and may coincide with PSH. While various factors can lead to the simultaneous occurrence of these syndromes, a notably rare scenario involves their manifestation after brain tumor removal. The nonspecific nature of PSH symptoms and of the cardiac dysfunction in takotsubo syndrome pose challenges in accurately diagnosing these conditions in an intensive care unit (ICU) setting. They often overlap with more prevalent diagnoses like sepsis, pulmonary embolism, and acute heart failure. Thus, it is crucial for clinicians dealing with these patients to be aware that symptoms indicating sympathetic activity surge and left heart failure might prompt consideration of takotsubo syndrome and PSH. This study presents the case of an 8-year-old girl who developed takotsubo syndrome associated with sympathetic hyperactivity following the surgical removal of a bulbar tumor. To the best of our knowledge, this is the tenth case of PSH following brain tumor removal in a pediatric patient and the first reported case of occurrence of takotsubo linked to PSH after brain tumor removal. We offer a detailed account of the patient's clinical journey in the ICU, accompanied by a comprehensive review of relevant literature to identify similar cases. The significance of this case study lies in emphasizing the potential occurrence of takotsubo syndrome due to PSH and underscores the importance of early diagnosis and management due to their association with unfavorable clinical outcomes.
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Affiliation(s)
- Manel Krouma
- Department of Neurosurgery, La Timone Hospital, Aix-Marseille University, Marseille, France
| | - A Aboudou Soilihi
- Department of Neurosurgery, La Timone Hospital, Aix-Marseille University, Marseille, France
| | - Gregoire Pech-Gourg
- Department of Neurosurgery, La Timone Hospital, Aix-Marseille University, Marseille, France
| | - Sophie Arnaud
- Department of Pediatric Anesthesiology and Intensive Care, La Timone Hospital, Aix-Marseille University, Marseille, France
| | - El Louali Fadoua
- Department of Pediatric and Congenital Cardiology, La Timone Hospital, Aix-Marseille University, Marseille, France
| | - Marco Caruselli
- Department of Pediatric Anesthesiology and Intensive Care, La Timone Hospital, Aix-Marseille University, Marseille, France
| | - Didier Scavarda
- Department of Neurosurgery, La Timone Hospital, Aix-Marseille University, Marseille, France.
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Demirel O, Paar V, Tolnai P, Topf A, Hoppe UC, Lichtenauer M, Mirna M. Heat Shock Protein 70 Constitutes a Promising Novel Biomarker in Differential Diagnosis between Takotsubo Syndrome and Non-ST-Segment Elevation Myocardial Infarction. J Clin Med 2024; 13:4152. [PMID: 39064192 PMCID: PMC11277720 DOI: 10.3390/jcm13144152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/04/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
(1) Background: Due to similar clinical presentation and a lack of specific biomarkers, initial differentiation between Takotsubo syndrome (TTS) and non-ST-segment elevation myocardial infarction (NSTEMI) remains challenging in daily practice. Heat Shock Protein 70 (HSP70) is a novel biomarker that is recognized for its potential in the diagnosis and differentiation of cardiovascular conditions. (2) Methods: Data from a total of 156 patients were analyzed (32.1% NSTEMI, 32.7% TTS, and 35.3% controls). Serum concentrations of HSP70 were determined using ELISA and compared between patients and controls. ROC curve analysis, logistic regression analysis and propensity-score-weighted logistic regression were conducted. (3) Results: Concentrations of HSP70 were highest in patients with TTS (median 1727 pg/mL vs. ACS: median 1545 pg/mL vs. controls: median 583 pg/mL, p < 0.0001). HSP70 was predictive for TTS in binary logistic regression analysis (B(SE) = 0.634(0.22), p = 0.004), which even remained significant after correction for possible confounders in propensity-score-weighted analysis. ROC curve analysis also revealed a significant association of HSP70 with TTS (AUC: 0.633, p = 0.008). (4) Conclusions: Based on our findings, HSP70 constitutes a promising biomarker for discrimination between TTS and NSTEMI, especially in combination with established cardiovascular biomarkers like pBNP or high-sensitivity cardiac troponin.
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Affiliation(s)
- Ozan Demirel
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (V.P.)
| | - Vera Paar
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (V.P.)
| | - Philipp Tolnai
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (V.P.)
| | - Albert Topf
- Hospital Villach, Department of Internal Medicine, 9500 Villach, Austria
| | - Uta C. Hoppe
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (V.P.)
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (V.P.)
| | - Moritz Mirna
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (V.P.)
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7
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Hein RD, Blancke JA, Schaller SJ. [Anaesthesiological Management of Traumatic Brain Injury]. Anasthesiol Intensivmed Notfallmed Schmerzther 2024; 59:420-437. [PMID: 39074788 DOI: 10.1055/a-2075-9299] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
Traumatic brain injury (TBI) is the main cause of death in people < 45 years in industrial countries. Minimising secondary injury to the injured brain is the primary goal throughout the entire treatment. Anaesthesiologic procedures aim at the reconstitution of cerebral perfusion and homeostasis. Both TBI itself as well as accompanying injuries show effects on cardiac and pulmonary function. Time management plays a crucial role in ensuring a safe anaesthesiologic environment while minimizing unnecessary procedures. Furthermore, growing medical drug pre-treatment demands for further knowledge e.g., in antagonization of anticoagulation.
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8
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Escaño L, Desai P, Chaudhry S. From Hyperglycemia to Broken Heart Syndrome: A Case of Diabetic Ketoacidosis-Induced Takotsubo Cardiomyopathy. Cureus 2024; 16:e64907. [PMID: 39156256 PMCID: PMC11330627 DOI: 10.7759/cureus.64907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2024] [Indexed: 08/20/2024] Open
Abstract
Diabetic ketoacidosis (DKA) is one of the hyperglycemic emergencies seen in patients with poorly controlled diabetes mellitus. One of the potential cardiovascular complications of this hyperglycemic crisis, not that well documented in the literature, is takotsubo cardiomyopathy (TCM) also known as stress-induced cardiomyopathy or "broken heart syndrome". It is a reversible condition where the heart muscle becomes suddenly weakened and stunned, which is mostly known to develop in patients who have suffered a stressful life event or are undergoing an acute illness. We present an interesting case of a 45-year-old female with a history of poorly controlled diabetes mellitus who presented with significant hyperglycemia and laboratory results concerning DKA. The patient was also complaining of new-onset chest pain on arrival. Further workup revealed elevated troponin, severely reduced ejection fraction, and echocardiographic findings concerning TCM. The coexistence of DKA and TCM is rare but clinically significant. This case emphasizes the value of clinical vigilance in patients with this hyperglycemic crisis and encourages us to always consider stress-induced cardiomyopathy as a potential complication. Further research is needed to better elucidate the exact mechanisms linking DKA and stress-induced cardiomyopathy. This will help improve outcomes and prevent recurrence in this vulnerable patient population.
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9
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McCallinhart PE, Chade AR, Bender SB, Trask AJ. Expanding landscape of coronary microvascular disease in co-morbid conditions: Metabolic disease and beyond. J Mol Cell Cardiol 2024; 192:26-35. [PMID: 38734061 DOI: 10.1016/j.yjmcc.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/26/2024] [Accepted: 05/08/2024] [Indexed: 05/13/2024]
Abstract
Coronary microvascular disease (CMD) and impaired coronary blood flow control are defects that occur early in the pathogenesis of heart failure in cardiometabolic conditions, prior to the onset of atherosclerosis. In fact, recent studies have shown that CMD is an independent predictor of cardiac morbidity and mortality in patients with obesity and metabolic disease. CMD is comprised of functional, structural, and mechanical impairments that synergize and ultimately reduce coronary blood flow in metabolic disease and in other co-morbid conditions, including transplant, autoimmune disorders, chemotherapy-induced cardiotoxicity, and remote injury-induced CMD. This review summarizes the contemporary state-of-the-field related to CMD in metabolic and these other co-morbid conditions based on mechanistic data derived mostly from preclinical small- and large-animal models in light of available clinical evidence and given the limitations of studying these mechanisms in humans. In addition, we also discuss gaps in current understanding, emerging areas of interest, and opportunities for future investigations in this field.
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Affiliation(s)
- Patricia E McCallinhart
- Center for Cardiovascular Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America
| | - Alejandro R Chade
- Department of Medical Pharmacology and Physiology, University of Missouri School of Medicine, Columbia, MO, United States of America; Department of Medicine, University of Missouri School of Medicine, Columbia, MO, United States of America
| | - Shawn B Bender
- Department of Biomedical Sciences, University of Missouri, Columbia, MO, United States of America; Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, United States of America; Research Service, Harry S Truman Memorial Veterans Hospital, Columbia, MO, United States of America.
| | - Aaron J Trask
- Center for Cardiovascular Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States of America.
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10
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Brettner F, Brettner F, Appelt W, Berlinger A, Perras J, Steindl D, Greb I. [Cardiac arrest after intoxication with an extremely high dose of venlafaxine. Bridge to recovery with extracorporeal life support]. DIE ANAESTHESIOLOGIE 2024; 73:408-411. [PMID: 38717642 DOI: 10.1007/s00101-024-01412-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 04/04/2024] [Accepted: 04/10/2024] [Indexed: 06/12/2024]
Affiliation(s)
- Florian Brettner
- Klinik für Anästhesiologie und Intensivmedizin, ARDS und ECMO Zentrum München-Nymphenburg, Krankenhaus Barmherzige Brüder München, Romanstr. 93, 80639, München, Deutschland
| | - Franz Brettner
- Klinik für Anästhesiologie und Intensivmedizin, ARDS und ECMO Zentrum München-Nymphenburg, Krankenhaus Barmherzige Brüder München, Romanstr. 93, 80639, München, Deutschland.
| | - Werner Appelt
- Klinik für Anästhesiologie und Intensivmedizin, ARDS und ECMO Zentrum München-Nymphenburg, Krankenhaus Barmherzige Brüder München, Romanstr. 93, 80639, München, Deutschland
| | - Angelika Berlinger
- Klinik für Anästhesiologie und Intensivmedizin, ARDS und ECMO Zentrum München-Nymphenburg, Krankenhaus Barmherzige Brüder München, Romanstr. 93, 80639, München, Deutschland
| | - Jan Perras
- Intensivmedizin, BG Unfallklinik Murnau, Murnau, Deutschland
| | - David Steindl
- Giftnotruf, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
- Medizinische Klinik mit Schwerpunkt Nephrologie und internistische Intensivmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Ingo Greb
- Giftnotruf, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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11
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Crea F, Iannaccone G, La Vecchia G, Montone RA. An update on the mechanisms of Takotsubo syndrome: "At the end an acute coronary syndrome". J Mol Cell Cardiol 2024; 191:1-6. [PMID: 38641224 DOI: 10.1016/j.yjmcc.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/13/2024] [Accepted: 04/10/2024] [Indexed: 04/21/2024]
Abstract
Takotsubo syndrome (TTS) is an acute reversible form of myocardial dysfunction, often preceded by a physical or emotional stressful event, that acts as a trigger. Despite, recent advances in the comprehension of the mechanisms leading to TTS, its pathophysiology is far from being completely understood. However, several studies seem to suggest that an acute coronary microvascular dysfunction may represent a crucial pathogenic mechanism involved in TTS occurrence. In this article, we aim to review the complex pathophysiology of TTS and the possible different mechanisms underlying this clinical condition, focusing on the role of coronary microvascular dysfunction and the remaining knowledge's gaps in the field.
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Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy.
| | - Giulia Iannaccone
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giulia La Vecchia
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Rocco A Montone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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12
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Wang Y, Tang X, Cui J, Wang P, Yang Q, Chen Y, Zhang T. Ginsenoside Rb1 mitigates acute catecholamine surge-induced myocardial injuries in part by suppressing STING-mediated macrophage activation. Biomed Pharmacother 2024; 175:116794. [PMID: 38776673 DOI: 10.1016/j.biopha.2024.116794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/14/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
Stress cardiomyopathy (SCM) is associated with cardiovascular mortality rates similar to acute coronary syndrome. Myocardial injuries driven by inflammatory mechanisms may in part account for the dismal prognosis of SCM. Currently, no inflammation-targeted therapies are available to mitigate SCM-associated myocardial injuries. In this study, acute catecholamine surge-induced SCM was modeled by stimulating the ovariectomized (OVX) mice with isoproterenol (ISO). The effects of ginsenoside Rb1 (Rb1) on SCM-associated myocardial injuries were assessed in the OVX-ISO compound mice. RAW 264.7 macrophages stimulated with calf thymus DNA (ctDNA) or STING agonist DMXAA were adopted to further understand the anti-inflammatory mechanisms of Rb1. The results show that estrogen deprivation increases the susceptibility to ISO-induced myocardial injuries. Rb1 mitigates myocardial injuries and attenuates cardiomyocyte necrosis as well as myocardial inflammation in the OVX-ISO mice. Bioinformatics analysis suggests that cytosolic DNA-sensing pathway is closely linked with ISO-triggered inflammatory responses and cell death in the heart. In macrophages, Rb1 lowers ctDNA-stimulated production of TNF-α, IL-6, CCL2 and IFN-β. RNA-seq analyses uncover that Rb1 offsets DNA-stimulated upregulation in multiple inflammatory response pathways and cytosolic DNA-sensing pathway. Furthermore, Rb1 directly mitigates DMXAA-stimulated STING activation and inflammatory responses in macrophages. In conclusion, the work here demonstrates for the first time that Rb1 protects against SCM-associated myocardial injuries in part by counteracting acute ISO stress-triggered cardiomyocyte necrosis and myocardial inflammation. Moreover, by evidencing that Rb1 downregulates cytosolic DNA-sensing machineries in macrophages, our findings warrant further investigation of therapeutic implications of the anti-inflammatory Rb1 in the treatment of SCM.
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Affiliation(s)
- Yujue Wang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Rd, Shanghai 200437, China
| | - Xinmiao Tang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Rd, Shanghai 200437, China
| | - Jingang Cui
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Rd, Shanghai 200437, China; Clinical Research Institute of Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, 110 Ganhe Rd, Shanghai 200437, China
| | - Peiwei Wang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Rd, Shanghai 200437, China; Clinical Research Institute of Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, 110 Ganhe Rd, Shanghai 200437, China
| | - Qinbo Yang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Rd, Shanghai 200437, China; Clinical Research Institute of Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, 110 Ganhe Rd, Shanghai 200437, China
| | - Yu Chen
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Rd, Shanghai 200437, China; Clinical Research Institute of Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, 110 Ganhe Rd, Shanghai 200437, China; Laboratory of Clinical and Molecular Pharmacology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Rd, Shanghai 200437, China.
| | - Teng Zhang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Rd, Shanghai 200437, China; Clinical Research Institute of Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, 110 Ganhe Rd, Shanghai 200437, China.
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13
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Gaddameedi SR, Thapa M, Arty F, Atreya S, Ravilla J, Panchal P, Du D. Case Report and Literature Review of an Anomalous Course of the Left Main Coronary Artery (LMCA) Arising From the Right Sinus of Valsalva (RSV) Presenting as Takotsubo Cardiomyopathy. Cureus 2024; 16:e63028. [PMID: 38919862 PMCID: PMC11197674 DOI: 10.7759/cureus.63028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 06/27/2024] Open
Abstract
Takotsubo cardiomyopathy (TC) mimics myocardial infarction with symptoms like chest pain, electrocardiogram (EKG) changes, and elevated troponin levels, although it typically features normal coronary arteries upon angiography. While often asymptomatic, coronary artery anomalies (CAAs) can cause intermittent vasospasm and endothelial dysfunction, potentially inducing TC. We report the case of a 74-year-old female with a history of hypertension, hyperlipidemia, and peripheral artery disease, who presented with sudden onset chest pain. Initial EKG and elevated troponin suggested myocardial infarction. However, coronary angiography revealed an anomalous left main coronary artery (LMCA) originating from the right coronary artery (RCA), with no significant stenosis. Subsequent transthoracic echocardiography indicated TC, with the left ventricular ejection fraction improving from 35-40% to 60-65% within days. Cardiac computed tomography angiography (CCTA) revealed that the anomalous LMCA originated from the common trunk at the right sinus of Valsalva (RSV), which further continued as a large, dominant RCA. The LMCA branched into a small to moderate left anterior descending artery (LAD) and a non-dominant left circumflex artery (LCx). The LMCA followed a prepulmonic/anterior course, while the LCx took an interarterial course between the aorta and pulmonary artery. The patient was referred for further surgical evaluation. We conclude that the CAA was an incidental finding and was not related to underlying TC. Although rare, this case suggests a possible correlation between CAAs and a predisposition to stress-induced cardiomyopathy, warranting further investigation.
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Affiliation(s)
| | - Milan Thapa
- Internal Medicine, Rutgers Health/Monmouth Medical Center, Long Branch, USA
| | - Fnu Arty
- Internal Medicine, Rutgers Health/Monmouth Medical Center, Long Branch, USA
| | - Suryansh Atreya
- Internal Medicine, Rutgers Health/Monmouth Medical Center, Long Branch, USA
| | - Jayasree Ravilla
- Internal Medicine, Rutgers Health/Monmouth Medical Center, Long Branch, USA
| | - Pratik Panchal
- Cardiology, Rutgers Health/Monmouth Medical Center, Long Branch, USA
| | - Doantrang Du
- Internal Medicine, Rutgers Health/Monmouth Medical Center, Long Branch, USA
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14
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Markousis-Mavrogenis G, Pepe A, Bacopoulou F, Lupi A, Quaia E, Chrousos GP, Mavrogeni SI. Combined Brain-Heart Imaging in Takotsubo Syndrome: Towards a Holistic Patient Assessment. J Clin Med 2024; 13:2991. [PMID: 38792532 PMCID: PMC11122389 DOI: 10.3390/jcm13102991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Takotsubo syndrome (TTS) is a type of cardiomyopathy usually precipitated by either emotional or physical stress and potentially leading to reversible heart failure. There is emerging evidence indicating an interaction between the brain and the heart in patients with TTS. Nevertheless, these new insights are not reflected in the current clinical approach to TTS. The application of novel and existing imaging modalities for the evaluation of brain-heart interactions is an interesting approach that could potentially augment diagnostic and prognostic yield, as well as improve our pathophysiologic understanding in the context of TTS. In this opinion piece, we discuss the evidence supporting a brain-heart interaction in patients with TTS and discuss how a combined evaluation of brain-heart interactions could potentially be implemented.
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Affiliation(s)
- George Markousis-Mavrogenis
- University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair in Adolescent Health Care, Medical School, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children’s Hospital, 11527 Athens, Greece; (G.M.-M.); (F.B.); (G.P.C.)
| | - Alessia Pepe
- Institute of Radiology, Department of Medicine, University of Padova, 35128 Padova, Italy; (A.P.); (A.L.); (E.Q.)
| | - Flora Bacopoulou
- University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair in Adolescent Health Care, Medical School, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children’s Hospital, 11527 Athens, Greece; (G.M.-M.); (F.B.); (G.P.C.)
| | - Amalia Lupi
- Institute of Radiology, Department of Medicine, University of Padova, 35128 Padova, Italy; (A.P.); (A.L.); (E.Q.)
| | - Emilio Quaia
- Institute of Radiology, Department of Medicine, University of Padova, 35128 Padova, Italy; (A.P.); (A.L.); (E.Q.)
| | - George P. Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair in Adolescent Health Care, Medical School, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children’s Hospital, 11527 Athens, Greece; (G.M.-M.); (F.B.); (G.P.C.)
| | - Sophie I. Mavrogeni
- University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair in Adolescent Health Care, Medical School, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children’s Hospital, 11527 Athens, Greece; (G.M.-M.); (F.B.); (G.P.C.)
- Onassis Cardiac Surgery Center, 17674 Athens, Greece
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15
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Qin S, Teng H, Li A, Wang L, Hu R, Fu D. Subarachnoid hemorrhage with Takotsubo syndrome as the prominent manifestation: A case and literature review. Heliyon 2024; 10:e30057. [PMID: 38694106 PMCID: PMC11059115 DOI: 10.1016/j.heliyon.2024.e30057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024] Open
Abstract
Background Takotsubo syndrome, which is often induced by physical or psychological stress, is typically a cardiac syndrome with transient left ventricular dysfunction in the absence of obstructive coronary artery disease. Subarachnoid hemorrhage with typical symptoms and signs is frequently reported, whereas the incidence of subarachnoid hemorrhage with Takotsubo syndrome as the prominent manifestation without a typical headache is rarely reported. Case description We present a rare case of a 63-year-old male patient with cough and fever as the first manifestations, accompanied by mild dizziness, headache, and mental discomfort; however, the patient was eventually diagnosed with atypical subarachnoid hemorrhage with Takotsubo syndrome. The patient underwent general anesthesia downwards stent-assisted spring coil embolization and was discharged from the hospital after postoperative treatment consisting of anti-cerebrovascular spasm, anti-platelet aggregation, and cerebrospinal fluid replacement. Conclusion This case demonstrates the association between Takotsubo syndrome and subarachnoid hemorrhage. When patients present with unexplained pulmonary edema with mild neurologic symptoms, clinicians should be alerted to subarachnoid hemorrhage and Takotsubo syndrome.
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Affiliation(s)
- Shihong Qin
- The Fifth Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- The Fifth Department of Pulmonary and Critical Care Medicine, Hunan Provincial People's Hospital, Changsha, China
| | - Huifang Teng
- The Fifth Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- The Fifth Department of Pulmonary and Critical Care Medicine, Hunan Provincial People's Hospital, Changsha, China
| | - Aiping Li
- The Fourth Department of Neurology, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- The Fourth Department of Neurology, Hunan Provincial People's Hospital, Changsha, China
| | - Lile Wang
- The Fifth Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- The Fifth Department of Pulmonary and Critical Care Medicine, Hunan Provincial People's Hospital, Changsha, China
| | - Ruicheng Hu
- The Fifth Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- The Fifth Department of Pulmonary and Critical Care Medicine, Hunan Provincial People's Hospital, Changsha, China
| | - Daiyan Fu
- The Fifth Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- The Fifth Department of Pulmonary and Critical Care Medicine, Hunan Provincial People's Hospital, Changsha, China
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16
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Dunham J, Horridge M, Lim JH, Lyons BM, Wiggen K. Case report: Naturally occurring neurogenic stunned myocardium in a dog secondary to status epilepticus. Front Vet Sci 2024; 11:1376107. [PMID: 38895716 PMCID: PMC11185869 DOI: 10.3389/fvets.2024.1376107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/22/2024] [Indexed: 06/21/2024] Open
Abstract
A 4-year-old male neutered Boston Terrier was presented with status epilepticus. He was diagnosed with idiopathic epilepsy and hospitalized with supportive care. During hospitalization, the patient developed both supraventricular and ventricular arrhythmias as well as focal left ventricular dyskinesis. Cardiac troponin I was significantly increased, which was supportive of myocardial damage. Neurogenic stunned myocardium was suspected, and the patient was treated and responded to esmolol. Follow-up echocardiography demonstrated the resolution of the ventricular dyskinesia. This report describes the clinical presentation, diagnostic findings, treatment, management, and outcome of the first reported case of naturally occurring neurogenic stunned myocardium in a dog. Electrocardiogram monitoring, cardiac troponin I, and echocardiography should be considered in patients presenting with seizure activity, especially when exhibiting cluster seizures or in status epilepticus.
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Affiliation(s)
- Jacob Dunham
- Department of Veterinary Medicine and Surgery, University of Missouri Veterinary Health Center, Columbia, MO, United States
| | - Mallory Horridge
- Cornell University Veterinary Specialists, Stamford, CT, United States
| | - Ji-Hey Lim
- Department of Veterinary Medicine and Surgery, University of Missouri Veterinary Health Center, Columbia, MO, United States
| | - Bridget M. Lyons
- Cornell University Veterinary Specialists, Stamford, CT, United States
| | - Kelly Wiggen
- Department of Veterinary Medicine and Surgery, University of Missouri Veterinary Health Center, Columbia, MO, United States
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17
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Dev D, El-Din M, Vijayakumar S, Mitrakrishnan RN. Takotsubo cardiomyopathy following pacemaker insertion complicated with polymorphic ventricular tachycardia: a case report. J Med Case Rep 2024; 18:238. [PMID: 38705996 PMCID: PMC11071207 DOI: 10.1186/s13256-024-04565-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/14/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Takotsubo cardiomyopathy is a novel form of rapidly reversible heart failure occurring secondary to a stressor that mimics an acute coronary event. The underlying etiology of the stressor is highly variable and can include medical procedures. Pacemaker insertion is an infrequent cause of Takotsubo cardiomyopathy. CASE PRESENTATION An 86-year-old Caucasian woman underwent an uncomplicated pacemaker insertion for symptomatic complete heart block in the background of slow atrial fibrillation. A transient episode of polymorphic ventricular tachycardia was noted on day 1 following the procedure; however, her pacemaker was checked and, as she remained stable, she was discharged home. She presented again 5 days later with symptomatic heart failure. Chest X-ray confirmed pulmonary edema. Echocardiography confirmed new onset severe left ventricle dysfunction. Pacemaker checks were normal and lead placement was confirmed. Though her troponin I was elevated, her coronary angiogram was normal. Contrast enhanced echocardiography suggested apical ballooning favoring Takotsubo cardiomyopathy. She was treated for heart failure and made a good recovery. Her follow-up echocardiography a month later showed significant improvement in left ventricle function. CONCLUSIONS Takotsubo cardiomyopathy is mediated by a neuro-cardiogenic mechanism due to hypothalamic-pituitary-adrenal axis activation. It generally has a good prognosis. Complications though uncommon, can occur and include arrhythmias. Pacemaker insertion as a precipitant stressor is an infrequent cause of Takotsubo cardiomyopathy. As pacemaker insertions are more frequent in the elderly age group, this phenomenon should be recognized as a potential complication.
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Affiliation(s)
- Damanpreet Dev
- Department of Cardiology, Kettering General Hospital, NHS, Kettering, UK.
| | - Mohammed El-Din
- Department of Cardiology, Kettering General Hospital, NHS, Kettering, UK
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18
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Aweimer A, Dietrich JW, Santoro F, Fàbregas MC, Mügge A, Núñez-Gil IJ, Vazirani R, Vedia O, Pätz T, Ragnatela I, Arcari L, Volpe M, Corbì-Pascual M, Martinez-Selles M, Almendro-Delia M, Sionis A, Uribarri A, Thiele H, Brunetti ND, Eitel I, Stiermaier T, Hamdani N, Abumayyaleh M, Akin I, El-Battrawy I. Takotsubo syndrome outcomes predicted by thyroid hormone signature: insights from cluster analysis of a multicentre registry. EBioMedicine 2024; 102:105063. [PMID: 38502972 PMCID: PMC10963195 DOI: 10.1016/j.ebiom.2024.105063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/28/2024] [Accepted: 03/03/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Recently, abnormal thyroid function was shown to be common in patients with Takotsubo syndrome (TTS), being classified into "endocrine-type" and "stress-type" responses. The aim of this study was to investigate the association between thyroid homeostasis and TTS in a larger international registry. METHODS In total 288 patients with TTS were enrolled through the GEIST multicentre registry from Germany, Italy and Spain. Thyrotropin (TSH), free T4 (FT4) and free T3 (FT3) concentrations were analysed at admission. Data were collected both retrospectively and prospectively from 2017 onwards. Primary endpoints included in-hospital and all-cause fatality, determined by cluster analysis using an unsupervised machine learning algorithm (k-medoids). FINDINGS Three clusters were identified, classifying TTS with low (TSLT), high (TSHT) and normal (TSNT) thyroid output, based on TSH and FT4 levels in relation to the median thyroid's secretory capacity (SPINA-GT). Although TSH and FT4 concentrations were similar among survivors and non-survivors, these clusters were significantly associated with patient outcomes. In the longitudinal Kaplan-Meier analysis including in- and out-of-hospital survival, the prognosis related to concentrations of TSH, FT4, and FT3 as well as SPINA-GT, deiodinase activity (SPINA-GD) and clusters. Patients in the TSHT cluster and with cardiogenic shock had a lower initial left ventricular ejection fraction (LVEF). INTERPRETATION This study suggests that thyroid hormones may impact the evolution and prognosis of TTS. The findings indicate that thyroid-derived biomarkers may help identify high-risk patients and pave the way for novel personalized and preventive therapeutic options. FUNDING This research was not funded by any public, commercial, or not-for-profit agencies.
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Affiliation(s)
- Assem Aweimer
- Cardiology and Angiology Department, Medical Hospital II, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, NRW, Germany.
| | - Johannes W Dietrich
- Diabetes, Endocrinology and Metabolism Section, Department of Medicine I, St. Josef University Hospital, Ruhr University of Bochum, Bochum, NRW, Germany; Diabetes Centre Bochum/Hattingen, St. Elisabeth Hospital Blankenstein, Im Vogelsang 5-11, Hattingen 45527, Germany; Centre for Rare Endocrine Diseases, Ruhr Centre for Rare Diseases (CeSER), Ruhr University Bochum and Witten/Herdecke University, Alexandrinenstr. 5, Bochum 44791, Germany; Centre for Diabetes Technology, Catholic Hospitals Bochum, Gudrunstr. 56, Bochum 44791, Germany; Centre for Thyroid Medicine, Catholic Hospitals Bochum, Gudrunstr. 56, Bochum 44791, Germany
| | - Francesco Santoro
- University of Foggia, Department of Medical and Surgical Sciences, Foggia, Italy
| | - Mireia Camins Fàbregas
- Diabetes, Endocrinology and Metabolism Section, Department of Medicine I, St. Josef University Hospital, Ruhr University of Bochum, Bochum, NRW, Germany; Diabetes Centre Bochum/Hattingen, St. Elisabeth Hospital Blankenstein, Im Vogelsang 5-11, Hattingen 45527, Germany; Centre for Rare Endocrine Diseases, Ruhr Centre for Rare Diseases (CeSER), Ruhr University Bochum and Witten/Herdecke University, Alexandrinenstr. 5, Bochum 44791, Germany; Centre for Diabetes Technology, Catholic Hospitals Bochum, Gudrunstr. 56, Bochum 44791, Germany; Centre for Thyroid Medicine, Catholic Hospitals Bochum, Gudrunstr. 56, Bochum 44791, Germany
| | - Andreas Mügge
- Cardiology and Angiology Department, Medical Hospital II, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, NRW, Germany
| | - Iván J Núñez-Gil
- Hospital Clínico Universitario San Carlos, Interventional Cardiology, Cardiovascular Institute, Madrid, Spain
| | - Ravi Vazirani
- Hospital Clínico Universitario San Carlos, Interventional Cardiology, Cardiovascular Institute, Madrid, Spain
| | - Oscar Vedia
- Hospital Clínico Universitario San Carlos, Interventional Cardiology, Cardiovascular Institute, Madrid, Spain
| | - Toni Pätz
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ilaria Ragnatela
- University of Foggia, Department of Medical and Surgical Sciences, Foggia, Italy
| | - Luca Arcari
- Institute of Cardiology, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, University of Rome Sapienza and IRCCS San Raffaele Rome, Italy
| | | | - Manuel Martinez-Selles
- Department of Cardiology, Hospital General Universitario Gregorio Marañon, CIBERCV, Madrid, Spain; Universidad Europea, Universidad Complutense, Madrid, Spain
| | | | - Alessandro Sionis
- Servicio de Cardiología, Hospital Virgen de la Macarena, Sevilla, Spain
| | - Aitor Uribarri
- Cardiology Service, Vall d'Hebron, University Hospital, Barcelona, Spain; CIBERCV, Madrid, Spain
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | | | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Nazha Hamdani
- Institut für Forschung und Lehre (IFL), Department of Molecular and Experimental Cardiology, Ruhr-University Bochum, Bochum, Germany; Institute of Physiology, Ruhr-University Bochum, Bochum, Germany
| | - Mohammad Abumayyaleh
- First Department of Medicine, Faculty of Medicine University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Ibrahim El-Battrawy
- Cardiology and Angiology Department, Medical Hospital II, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, NRW, Germany
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Lang FM, Sajorda BJR, Pagan-Mendez M, Lowe H, Ali SR. Takotsubo cardiomyopathy as the primary manifestation of decompensated Graves' disease. J Cardiol Cases 2024; 29:178-181. [PMID: 38646084 PMCID: PMC11031651 DOI: 10.1016/j.jccase.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/30/2023] [Accepted: 12/21/2023] [Indexed: 04/23/2024] Open
Abstract
Takotsubo cardiomyopathy (TCM) is characterized by transient left ventricular dysfunction with apical ballooning, usually observed in postmenopausal women after a stressful event. We discuss a rare presentation of TCM induced by thyrotoxicosis secondary to Graves' disease. This case raises interesting questions about the pathogenesis, diagnosis, and management of TCM. Learning objectives 1. To recognize hyperthyroidism as a possible etiology of takutsubo cardiomyopathy.2. To identify the effect of radioiodine contrast on diagnosis of some types of takutsubo cardiomyopathy.
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Affiliation(s)
- Frederick M. Lang
- Division of Cardiology, Department of Medicine, New York Presbyterian-Columbia University Irving Medical Center, New York, NY, USA
| | - Brian Joseph Revilla Sajorda
- Division of Cardiology, Department of Medicine, New York Presbyterian-Columbia University Irving Medical Center, New York, NY, USA
| | - Maria Pagan-Mendez
- Division of Endocrinology, Department of Medicine, New York Presbyterian-Columbia University Irving Medical Center, New York, NY, USA
| | - Hyesoo Lowe
- Division of Endocrinology, Department of Medicine, New York Presbyterian-Columbia University Irving Medical Center, New York, NY, USA
| | - Shah R. Ali
- Division of Cardiology, Department of Medicine, New York Presbyterian-Columbia University Irving Medical Center, New York, NY, USA
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20
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Elkattawy O, Sames A, Kunamneni S, Sutariya R, Ismail M, Mohamed O, Lee TJ, Javed J, Elkattawy S, Hossain A, Shamoon F. Pulmonary Embolism in Patients Admitted With Takotsubo Cardiomyopathy: Prevalence and Associated In-Hospital Adverse Events. Cureus 2024; 16:e59268. [PMID: 38813344 PMCID: PMC11135138 DOI: 10.7759/cureus.59268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2024] [Indexed: 05/31/2024] Open
Abstract
Introduction Takotsubo cardiomyopathy (TCM) is a poorly understood condition typically characterized by abnormal left ventricular wall motion without causative coronary artery disease and typically presents in post-menopausal women after the experience of a physical or emotional stressor. The pathophysiology of TCM is complex and multifactorial, resulting in complications with varied severity; one of the most concerning complications is thromboembolism, specifically, pulmonary embolism (PE), which is understudied in its relation to TCM. The purpose of this study was to characterize and evaluate the real-world prevalence and outcomes of PE in TCM. Methods Data were derived from the National Inpatient Sample database from January 2016 to December 2019. The primary outcomes assessed were baseline and hospital admission characteristics and comorbidities for patients with TCM with and without PE. Outcomes for TCM patients with PE and predictors of mortality in TCM were also analyzed. Results PE developed in 788 of 40,120 patients with TCM (1.96%). After multivariate adjustment, PE was found to be independently associated with intracardiac thrombus (adjusted odds ratio (aOR) 2.067; 95% confidence interval (CI): 1.198-3.566; p = 0.009) and right heart catheterization (RHC) (aOR: 1.971; 95% CI: 1.160-3.350; p = 0.012). Mortality in patients with TCM was associated with, among other factors, age in years at admission (aOR: 1.104; 95% CI: 1.010-1.017; p = 0.001), African American race (aOR: 1.191; 95% CI: 1.020-1.391; p = 0.027), Asian or Pacific Islander race (aOR: 1.637; 95% CI: 1.283-2.090; p = 0.001), coagulopathy (aOR: 3.393; 95% CI: 2.889-2.986; p = 0.001), liver disease (aOR: 1.446; 95% CI: 1.147-1.824; p = 0.002), atrial fibrillation (aOR: 1.460; 95% CI: 1.320-1.615; p = 0.001), and pulmonary embolism (aOR: 2.217; 95% CI: 1.781-2.760; p = 0.001). Conclusion In a large cohort of patients admitted with TCM, we found the prevalence of PE to be 1.96%. PE, along with comorbidities such as coagulopathy and atrial fibrillation, was found to be a significant predictor of mortality in this patient cohort.
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Affiliation(s)
- Omar Elkattawy
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Antonia Sames
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Sruthi Kunamneni
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Riya Sutariya
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Mohamed Ismail
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Omar Mohamed
- Medicine, Saint Barnabas Medical Center, Livingston, USA
| | - Thomas J Lee
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Jahanzeb Javed
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Sherif Elkattawy
- Cardiology, Saint Joseph's University Medical Center, Paterson, USA
| | - Afif Hossain
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Fayez Shamoon
- Cardiology, Saint Joseph's University Medical Center, Paterson, USA
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21
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Giovannico L, Fischetti G, Mazzone F, Parigino D, Savino L, Santeramo V, Silva AM, di Bari N, Acquaviva T, Fiore G, Milano AD, Bottio T. Can a "broken heart" successfully be transplanted? A brief report. Clin Transplant 2024; 38:e15303. [PMID: 38551461 DOI: 10.1111/ctr.15303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 03/13/2024] [Accepted: 03/18/2024] [Indexed: 04/02/2024]
Abstract
A 59-year-old woman, with dilated ischemic cardiomyopathy, was urgently admitted to our Intensive Care Unit for cardiogenic shock. ECMO VA was implanted and placed on the national emergency waitlist for transplantation. A potential donation was identified ten days later. The donor was a 58-year-old woman, with no cardiovascular risk factors, had died of a rupture of a cerebral aneurysm with left ventricle dysfunction due to Takotsubo syndrome. Brain injuries such as hemorrhage, trauma and stroke have been extensively documented in literature to cause a surge in stress hormones, such as catecholamines. Such a surge can have a direct effect on the heart, resulting in a transient myocardial dysfunction commonly referred to as "Takotsubo cardiomyopathy" or "broken heart syndrome". Many studies have shown that hearts that are dysfunctional at the start of transplant screening, with normal contractile function at the time of organ retrieval, have similar outcomes to hearts that do not have dysfunction. In our case, the transplanted heart, at the time of sampling, still had moderate dysfunction (EF 40%) which completely disappeared after the transplant.
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Affiliation(s)
- Lorenzo Giovannico
- Cardiac Surgery Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Medical School, Bari, Italy
| | - Giuseppe Fischetti
- Cardiac Surgery Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Medical School, Bari, Italy
| | - Federica Mazzone
- Cardiac Surgery Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Medical School, Bari, Italy
| | - Domenico Parigino
- Cardiac Surgery Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Medical School, Bari, Italy
| | - Luca Savino
- Cardiac Surgery Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Medical School, Bari, Italy
| | - Vincenzo Santeramo
- Cardiac Surgery Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Medical School, Bari, Italy
| | - Aline Maria Silva
- Cardiac Surgery Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Medical School, Bari, Italy
| | - Nicola di Bari
- Cardiac Surgery Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Medical School, Bari, Italy
| | - Tommaso Acquaviva
- Cardiac Surgery Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Medical School, Bari, Italy
| | - Giuseppe Fiore
- Intensive Care Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Medical School, Bari, Italy
| | - Aldo Domenico Milano
- Cardiac Surgery Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Medical School, Bari, Italy
| | - Tomaso Bottio
- Cardiac Surgery Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Medical School, Bari, Italy
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22
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Kennedy KG, Ghugre NR, Roifman I, Qi X, Saul K, McCrindle BW, Macgowan CK, MacIntosh BJ, Goldstein BI. Impaired coronary microvascular reactivity in youth with bipolar disorder. Psychol Med 2024; 54:1196-1206. [PMID: 37905407 DOI: 10.1017/s0033291723003021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is excessively prevalent and premature in bipolar disorder (BD), even after controlling for traditional cardiovascular risk factors. The increased risk of CVD in BD may be subserved by microvascular dysfunction. We examined coronary microvascular function in relation to youth BD. METHODS Participants were 86 youth, ages 13-20 years (n = 39 BD, n = 47 controls). Coronary microvascular reactivity (CMVR) was assessed using quantitative T2 magnetic resonance imaging during a validated breathing-paradigm. Quantitative T2 maps were acquired at baseline, following 60-s of hyperventilation, and every 10-s thereafter during a 40-s breath-hold. Left ventricular structure and function were evaluated based on 12-15 short- and long-axis cardiac-gated cine images. A linear mixed-effects model that controlled for age, sex, and body mass index assessed for between-group differences in CMVR (time-by-group interaction). RESULTS The breathing-paradigm induced a significant time-related increase in T2 relaxation time for all participants (i.e. CMVR; β = 0.36, p < 0.001). CMVR was significantly lower in BD v. controls (β = -0.11, p = 0.002). Post-hoc analyses found lower T2 relaxation time in BD youth after 20-, 30-, and 40 s of breath-holding (d = 0.48, d = 0.72, d = 0.91, respectively; all pFDR < 0.01). Gross left ventricular structure and function (e.g. mass, ejection fraction) were within normal ranges and did not differ between groups. CONCLUSION Youth with BD showed evidence of subclinically impaired coronary microvascular function, despite normal gross cardiac structure and function. These results converge with prior findings in adults with major depressive disorder and post-traumatic stress disorder. Future studies integrating larger samples, prospective follow-up, and blood-based biomarkers are warranted.
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Affiliation(s)
- Kody G Kennedy
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Nilesh R Ghugre
- Schulich Heart Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Idan Roifman
- Schulich Heart Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Xiuling Qi
- Schulich Heart Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kayla Saul
- Schulich Heart Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Brian W McCrindle
- Division of Pediatric Cardiology, Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher K Macgowan
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Division of Translational Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Computational Radiology & Artificial Intelligence (CRAI) unit, Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
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23
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Rosso M, Stengl H, Ganeshan R, Hellwig S, Klammer MG, von Rennenberg R, Böhme S, Nolte CH, Audebert HJ, Endres M, Kasner SE, Scheitz JF. Sex Differences in Outcomes of Acute Myocardial Injury After Stroke. J Am Heart Assoc 2024; 13:e032755. [PMID: 38410952 PMCID: PMC10944046 DOI: 10.1161/jaha.123.032755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/11/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Sex differences in presentation, treatment, and prognosis of cardiovascular disorders are well recognized. Although an association between acute myocardial injury and mortality after ischemic stroke has been demonstrated, it is unclear whether prevalence and outcome of poststroke acute myocardial injury differ between women and men. METHODS AND RESULTS We prospectively screened consecutive patients with acute ischemic stroke and serial high-sensitivity cardiac troponin T measurements admitted to our center. Acute myocardial injury was defined as at least 1 high-sensitivity cardiac troponin T value above the upper reference limit (14 ng/L) with a rise/fall of >20%. Rates of acute myocardial injury were also calculated using sex-specific high-sensitivity cardiac troponin T cutoffs (women upper reference limit, 9 ng/L; men upper reference limit, 16 ng/L). Logistic regression analyses were performed to evaluate the association between acute myocardial injury and outcomes. Of 1067 patients included, 494 were women (46%). Women were older, had a higher rate of known atrial fibrillation, were more likely to be functionally dependent before admission, had higher stroke severity, and more often had cardioembolic strokes (all P values <0.05). The crude prevalence of acute myocardial injury differed by sex (29% women versus 23% men, P=0.024). Statistically significant associations between acute myocardial injury and outcomes were observed in women (7-day in-hospital mortality: adjusted odds ratio [aOR], 3.2 [95% CI, 1.07-9.3]; in-hospital mortality: aOR, 3.3 [95% CI, 1.4-7.6]; modified Rankin Scale score at discharge: aOR, 1.6 [95% CI, 1.1-2.4]) but not in men. The implementation of sex-specific cutoffs did not increase the prognostic value of acute myocardial injury for unfavorable outcomes. CONCLUSIONS The prevalence of acute myocardial injury after ischemic stroke and its association with mortality and greater disability might be sex-dependent. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03892226.
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Affiliation(s)
- Michela Rosso
- Department of Neurology University of Pennsylvania Philadelphia PA USA
| | - Helena Stengl
- Department of Neurology Charité - Universitätsmedizin Berlin Berlin Germany
- Center for Stroke Research Berlin (CSB) Charité - Universitätsmedizin Berlin Berlin Germany
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin Berlin Germany
| | - Ramanan Ganeshan
- Department of Neurology Charité - Universitätsmedizin Berlin Berlin Germany
- Center for Stroke Research Berlin (CSB) Charité - Universitätsmedizin Berlin Berlin Germany
| | - Simon Hellwig
- Department of Neurology Charité - Universitätsmedizin Berlin Berlin Germany
- Center for Stroke Research Berlin (CSB) Charité - Universitätsmedizin Berlin Berlin Germany
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin Berlin Germany
| | - Markus G Klammer
- Department of Neurology Charité - Universitätsmedizin Berlin Berlin Germany
- Center for Stroke Research Berlin (CSB) Charité - Universitätsmedizin Berlin Berlin Germany
| | - Regina von Rennenberg
- Department of Neurology Charité - Universitätsmedizin Berlin Berlin Germany
- Center for Stroke Research Berlin (CSB) Charité - Universitätsmedizin Berlin Berlin Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin Germany
| | - Sophie Böhme
- Department of Neurology Charité - Universitätsmedizin Berlin Berlin Germany
- Center for Stroke Research Berlin (CSB) Charité - Universitätsmedizin Berlin Berlin Germany
| | - Christian H Nolte
- Department of Neurology Charité - Universitätsmedizin Berlin Berlin Germany
- Center for Stroke Research Berlin (CSB) Charité - Universitätsmedizin Berlin Berlin Germany
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin Berlin Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin Germany
| | - Heinrich J Audebert
- Department of Neurology Charité - Universitätsmedizin Berlin Berlin Germany
- Center for Stroke Research Berlin (CSB) Charité - Universitätsmedizin Berlin Berlin Germany
| | - Matthias Endres
- Department of Neurology Charité - Universitätsmedizin Berlin Berlin Germany
- Center for Stroke Research Berlin (CSB) Charité - Universitätsmedizin Berlin Berlin Germany
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin Berlin Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin Germany
- German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin Germany
- German Center for Mental Health (DZPG) Partner Site Berlin Germany
| | - Scott E Kasner
- Department of Neurology University of Pennsylvania Philadelphia PA USA
| | - Jan F Scheitz
- Department of Neurology Charité - Universitätsmedizin Berlin Berlin Germany
- Center for Stroke Research Berlin (CSB) Charité - Universitätsmedizin Berlin Berlin Germany
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin Berlin Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin Germany
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24
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Cai M, Wu P, Ni W, Huang D, Wang X. mTORC1 hyperactivation and resultant suppression of macroautophagy contribute to the induction of cardiomyocyte necroptosis by catecholamine surges. Physiol Rep 2024; 12:e15966. [PMID: 38444056 PMCID: PMC10915131 DOI: 10.14814/phy2.15966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/17/2024] [Accepted: 02/26/2024] [Indexed: 03/07/2024] Open
Abstract
Previous studies revealed a controversial role of mechanistic target of rapamycin complex 1 (mTORC1) and mTORC1-regulated macroautophagy in isoproterenol (ISO)-induced cardiac injury. Here we investigated the role of mTORC1 and potential underlying mechanisms in ISO-induced cardiomyocyte necrosis. Two consecutive daily injections of ISO (85 mg/kg, s.c.) or vehicle control (CTL) were administered to C57BL/6J mice with or without rapamycin (RAP, 5 mg/kg, i.p.) pretreatment. Western blot analyses showed that myocardial mTORC1 signaling and the RIPK1-RIPK3-MLKL necroptotic pathway were activated, mRNA expression analyses revealed downregulation of representative TFEB target genes, and Evan's blue dye uptake assays detected increased cardiomyocyte necrosis in ISO-treated mice. However, RAP pretreatment prevented or significantly attenuated the ISO-induced cardiomyocyte necrosis, myocardial inflammation, downregulation of TFEB target genes, and activation of the RIPK1-RIPK3-MLKL pathway. LC3-II flux assays confirmed the impairment of myocardial autophagic flux in the ISO-treated mice. In cultured neonatal rat cardiomyocytes, mTORC1 signaling was also activated by ISO, and inhibition of mTORC1 by RAP attenuated ISO-induced cytotoxicity. These findings suggest that mTORC1 hyperactivation and resultant suppression of macroautophagy play a major role in the induction of cardiomyocyte necroptosis by catecholamine surges, identifying mTORC1 inhibition as a potential strategy to treat heart diseases with catecholamine surges.
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Affiliation(s)
- Mingqi Cai
- Heart CenterShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Division of Basic Biomedical SciencesSanford School of Medicine of the University of South DakotaVermillionSouth DakotaUSA
| | - Penglong Wu
- Division of Basic Biomedical SciencesSanford School of Medicine of the University of South DakotaVermillionSouth DakotaUSA
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of MedicineXiamen UniversityXiamenChina
| | - Wei Ni
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of MedicineXiamen UniversityXiamenChina
| | - Dong Huang
- Heart CenterShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Xuejun Wang
- Division of Basic Biomedical SciencesSanford School of Medicine of the University of South DakotaVermillionSouth DakotaUSA
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25
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Pei Q, Yang J, Li B, Lin P, Zou L, Zhang J, Yin H, Sun J, Wang X, Vera A N, Dong Z, Yin D. Histological and functional assessment of a Takotsubo cardiomyopathy model established by immobilization stress. Pacing Clin Electrophysiol 2024; 47:373-382. [PMID: 38341623 DOI: 10.1111/pace.14930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 10/20/2023] [Accepted: 01/04/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Takotsubo cardiomyopathy (TTC), also known as stress-induced cardiomyopathy, resembles acute heart failure syndrome but lacks disease-specific diagnosis and treatment strategies. TTC accounts for approximately 5-6% of all suspected cases of acute coronary syndrome in women. At present, animal models of TTC are often created by large amounts of exogenous catecholamines such as isoproterenol. However, isoproterenol injection cannot fully simulate the onset of stress-induced cardiomyopathy in humans since stress is not an instantaneous event. METHODS Rats were immobilized for 6 h per day for 1-14 days. To examine whether the TTC model was successful, echocardiography was employed; Elisa detected serum sympathetic activation markers; and the Open-Field test (OFT) was used to analyze behavioral changes in rats after stress. Western blot and histology were used to assess sympathetic remodeling, inflammation levels, and fibrosis; qRT-PCR was used to explore the levels of fibrosis and myocardial hypertrophy. The electrical stability of ventricular was determined by electrophysiological testing. RESULTS The rats showed severe stress behavior and local sympathetic remodeling of the heart after only 1 day of stress. After 3 days of stress, the induction of ventricular tachyarrhythmia increased prominently. The highest incidence of TTC in rats was at 5 days of immobilization stress. The pathological left ventricular remodeling caused by immobilization (IMO) stress includes inflammatory infiltration, fibrosis, and myocardial hypertrophy. CONCLUSIONS Our study confirms the hypothesis that IMO stress can mimic Takotsubo cardiomyopathy, and the various effects on the heart depending on the duration of IMO stress. We observed the highest incidence of TTC occurred after 5 days of stress. Furthermore, there is a gradual occurrence of electrical and structural remodeling as the stress duration prolongs.
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Affiliation(s)
- Quanwei Pei
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiemei Yang
- Department of Echocardiography, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bin Li
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Pengqi Lin
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lina Zou
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Junpei Zhang
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hongpeng Yin
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jingmei Sun
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xin Wang
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Nevzorova Vera A
- Institute Therapy and Instrumental Diagnostic, Pacific State Medical University, Vladivostok, Russia
| | - Zengxiang Dong
- The Key Laboratory of Cardiovascular Disease Acousto-Optic Electromagnetic Diagnosis and Treatment in Heilongjiang Province, the First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Dechun Yin
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
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26
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Mishra T, Saha R, Paramasivam G. Takotsubo cardiomyopathy in India and its electrocardiography (ECG) comparison to myocardial infarction. Egypt Heart J 2024; 76:26. [PMID: 38381355 PMCID: PMC10881923 DOI: 10.1186/s43044-024-00453-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/08/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Owing to the limited research on Takotsubo Cardiomyopathy (TCM) in Asia, we aim to evaluate in detail the clinical profiles, lab parameters, investigations, and major adverse cardiovascular events (MACE) seen in patients with TCM in the Indian subcontinent. Additionally, we have compared the electrocardiographic findings of patients with TCM to those of patients with myocardial infarction (MI). RESULTS The average age of the patients affected was found to be 60 ± 11 years. Women (87.5%) and patients with hypertension (40%) were found to be at an increased risk of developing the syndrome. The most common presenting symptom was dyspnea (48%) following a trigger most commonly emotional (45%). ST elevation and significant T wave inversions were observed in 40% of patients with TCM. Echocardiography revealed a low left ventricular ejection fraction of 43 ± 9%. Coronary angiography was normal in 60%, the rest had mild/subcritical stenoses. The 6-month MACE was 20% and the mortality rate was 7.5%. Follow-up echocardiography of patients with TCM showed improvement in EF in 75% patients. CONCLUSIONS TCM was majorly seen in postmenopausal women following an emotional trigger, but a variety of other triggers were noted. T-wave inversions in TCM follow a diffuse pattern in contrast to specific leads seen in MI. Normal or subcritical stenosis in coronaries at presentation, along with a low EF which improves on follow up provide greater evidence for the diagnosis of TCM.
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Affiliation(s)
- Tanisha Mishra
- Department of Cardiology, Manipal Academy of Higher Education, Kasturba Medical College, Manipal, Manipal, Karnataka, 576104, India
| | - Rijushree Saha
- Department of Cardiology, Manipal Academy of Higher Education, Kasturba Medical College, Manipal, Manipal, Karnataka, 576104, India
| | - Ganesh Paramasivam
- Department of Cardiology, Manipal Academy of Higher Education, Kasturba Medical College, Manipal, Manipal, Karnataka, 576104, India.
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27
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Fazzini L, Casati M, Martis A, Perra F, Rubiolo P, Deidda M, Mercuro G, Cadeddu Dessalvi C. Gender Effect on Clinical Profiles, Pharmacological Treatments and Prognosis in Patients Hospitalized for Heart Failure. J Clin Med 2024; 13:881. [PMID: 38337574 PMCID: PMC10856570 DOI: 10.3390/jcm13030881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Heart failure (HF) is a significant disease affecting 1-2% of the general population. Despite its general aspects, HF, like other cardiovascular diseases, presents various gender-specific aspects in terms of etiology, hemodynamics, clinical characteristics, therapy, and outcomes. As is well known, HF with preserved ejection fraction more frequently affects females, with diabetes and arterial hypertension representing the most critical determinants of HF. On the other hand, women are traditionally underrepresented in clinical trials and are often considered undertreated. However, it is not clear whether such differences reflect cultural behaviors and clinical inertia or if they indicate different clinical profiles and the impact of sex on hard clinical outcomes. We aimed to review the sex-related differences in patients affected by HF.
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Affiliation(s)
- Luca Fazzini
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (L.F.); (M.C.); (A.M.); (F.P.); (P.R.); (G.M.); (C.C.D.)
| | - Mattia Casati
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (L.F.); (M.C.); (A.M.); (F.P.); (P.R.); (G.M.); (C.C.D.)
| | - Alessandro Martis
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (L.F.); (M.C.); (A.M.); (F.P.); (P.R.); (G.M.); (C.C.D.)
| | - Ferdinando Perra
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (L.F.); (M.C.); (A.M.); (F.P.); (P.R.); (G.M.); (C.C.D.)
| | - Paolo Rubiolo
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (L.F.); (M.C.); (A.M.); (F.P.); (P.R.); (G.M.); (C.C.D.)
| | - Martino Deidda
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (L.F.); (M.C.); (A.M.); (F.P.); (P.R.); (G.M.); (C.C.D.)
- Sassu Cardiologic Center, Cittadella Universitaria, 09033 Sardinia, Italy
| | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (L.F.); (M.C.); (A.M.); (F.P.); (P.R.); (G.M.); (C.C.D.)
| | - Christian Cadeddu Dessalvi
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (L.F.); (M.C.); (A.M.); (F.P.); (P.R.); (G.M.); (C.C.D.)
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Park S, Kim M, Lee DI, Lee JH, Kim S, Lee SY, Bae JW, Hwang KK, Kim DW, Cho MC, Bae DH. Successful extracorporeal membrane oxygenation treatment of catecholamine-induced cardiomyopathy-associated pheochromocytoma: a case report. Acute Crit Care 2024; 39:194-198. [PMID: 35545235 PMCID: PMC11002611 DOI: 10.4266/acc.2021.01158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022] Open
Abstract
The main mechanism of Takotsubo cardiomyopathy (TCM) is catecholamine-induced acute myocardial stunning. Pheochromocytoma, a catecholamine-secreting tumor, can cause several cardiovascular complications, including hypertensive crisis, myocardial infarction, toxic myocarditis, and TCM. A 29-year-old woman presented to our hospital with general weakness, vomiting, dyspnea, and chest pain. The patient was nullipara, 28 weeks' gestation, and had a cachexic morphology. Her cardiac enzyme levels were elevated and bedside echocardiography showed apical akinesia, suggesting TCM. The next day, she could not feel the fetal movement, and an emergency cesarean section was performed. After delivery, the patient experienced cardiac arrest and was transferred to the intensive care unit for cardiopulmonary resuscitation (CPR). Spontaneous circulation returned after 28 minutes of CPR, but cardiogenic shock continued, and extracorporeal membrane oxygenation (ECMO) was initiated. On the third day of ECMO maintenance, left ventricular ejection fraction improved and blood pressure stabilized. On the eighth day after ECMO insertion, it was removed. However, complications of the left leg vessels occurred, and several surgeries and interventions were performed. A left adrenal gland mass was found on computed tomography and was removed while repairing the leg vessels. Pheochromocytoma was diagnosed and left adrenalectomy was performed.
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Affiliation(s)
- Sangshin Park
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Min Kim
- Regional Cardiovascular Disease Center, Chungbuk National University Hospital, Cheongju, Korea
| | - Dae In Lee
- Regional Cardiovascular Disease Center, Chungbuk National University Hospital, Cheongju, Korea
| | - Ju-Hee Lee
- Regional Cardiovascular Disease Center, Chungbuk National University Hospital, Cheongju, Korea
| | - Sangmin Kim
- Regional Cardiovascular Disease Center, Chungbuk National University Hospital, Cheongju, Korea
| | - Sang Yeub Lee
- Regional Cardiovascular Disease Center, Chungbuk National University Hospital, Cheongju, Korea
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jang-Whan Bae
- Regional Cardiovascular Disease Center, Chungbuk National University Hospital, Cheongju, Korea
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Kyung-Kuk Hwang
- Regional Cardiovascular Disease Center, Chungbuk National University Hospital, Cheongju, Korea
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Dong-Woon Kim
- Regional Cardiovascular Disease Center, Chungbuk National University Hospital, Cheongju, Korea
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Myeong-Chan Cho
- Regional Cardiovascular Disease Center, Chungbuk National University Hospital, Cheongju, Korea
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Dae-Hwan Bae
- Regional Cardiovascular Disease Center, Chungbuk National University Hospital, Cheongju, Korea
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29
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Frank N, Herrmann MJ, Lauer M, Förster CY. Exploratory Review of the Takotsubo Syndrome and the Possible Role of the Psychosocial Stress Response and Inflammaging. Biomolecules 2024; 14:167. [PMID: 38397404 PMCID: PMC10886847 DOI: 10.3390/biom14020167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
Takotsubo syndrome (TTS) is a cardiomyopathy that clinically presents as a transient and reversible left ventricular wall motion abnormality (LVWMA). Recovery can occur spontaneously within hours or weeks. Studies have shown that it mainly affects older people. In particular, there is a higher prevalence in postmenopausal women. Physical and emotional stress factors are widely discussed and generally recognized triggers. In addition, the hypothalamic-pituitary-adrenal (HPA) axis and the associated glucocorticoid-dependent negative feedback play an important role in the resulting immune response. This review aims to highlight the unstudied aspects of the trigger factors of TTS. The focus is on emotional stress/chronic unpredictable mild stress (CUMS), which is influenced by estrogen concentration and noradrenaline, for example, and can lead to changes in the behavioral, hormonal, and autonomic systems. Age- and gender-specific aspects, as well as psychological effects, must also be considered. We hypothesize that this leads to a stronger corticosteroid response and altered feedback of the HPA axis. This may trigger proinflammatory markers and thus immunosuppression, inflammaging, and sympathetic overactivation, which contributes significantly to the development of TTS. The aim is to highlight the importance of CUMS and psychological triggers as risk factors and to make an exploratory proposal based on the new knowledge. Based on the imbalance between the sympathetic and parasympathetic nervous systems, transcutaneous vagus nerve stimulation (tVNS) is presented as a possible new therapeutic approach.
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Affiliation(s)
- Niklas Frank
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg University, 97080 Würzburg, Germany
| | - Martin J. Herrmann
- Center of Mental Health, Department of Psychiatry and Psychotherapy, University Hospital Würzburg, 97080 Würzburg, Germany; (M.J.H.); (M.L.)
| | - Martin Lauer
- Center of Mental Health, Department of Psychiatry and Psychotherapy, University Hospital Würzburg, 97080 Würzburg, Germany; (M.J.H.); (M.L.)
| | - Carola Y. Förster
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg University, 97080 Würzburg, Germany
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Stępień K, Nowak K, Karcińska A, Horosin G, del Carmen Yika A, Lenart J, Górowska A, Iwańczyk S, Podolec M, Siniarski A, Nessler J, Zalewski J. Coronary Slow-Flow Phenomenon in Takotsubo Syndrome: The Prevalence, Clinical Determinants, and Long-Term Prognostic Impact. Int J Mol Sci 2024; 25:1297. [PMID: 38279297 PMCID: PMC10816693 DOI: 10.3390/ijms25021297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/28/2024] Open
Abstract
Patients with takotsubo syndrome (TTS) may present coronary slow flow (CSF) in angiography performed in the acute myocardial infarction (MI). However, the detailed clinical relevance and its long-term impact remain poorly understood. Among 7771 MI patients hospitalized between 2012 and 2019, TTS was identified in 82 (1.1%) subjects. The epicardial blood flow was assessed with thrombolysis in myocardial infarction (TIMI) scale and corrected TIMI frame count (TFC), whereas myocardial perfusion with TIMI myocardial perfusion grade (TMPG). CSF was defined as TIMI-2 or corrected TFC > 27 frames in at least one epicardial vessel. CSF was identified in 33 (40.2%) TTS patients. In the CSF-TTS versus normal-flow-TTS group, lower values of left ventricular ejection fraction on admission (33.5 (25-40) vs. 40 (35-45)%, p = 0.019), more frequent midventricular TTS (27.3 vs. 8.2%, p = 0.020) and the coexistence of both physical and emotional triggers (9.1 vs. 0%, p = 0.032) were noted. Within a median observation of 55 months, higher all-cause mortality was found in CSF-TTS compared with normal-flow TTS (30.3 vs. 10.2%, p = 0.024). CSF was identified as an independent predictor of long-term mortality (hazard ratio 10.09, 95% confidence interval 2.12-48.00, p = 0.004). CSF identified in two-fifths of TTS patients was associated with unfavorable long-term outcomes.
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Affiliation(s)
- Konrad Stępień
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (M.P.); (A.S.); (J.N.); (J.Z.)
- Department of Thromboembolic Disorders, Jagiellonian University Medical College, 31-202 Krakow, Poland
| | - Karol Nowak
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (M.P.); (A.S.); (J.N.); (J.Z.)
- Department of Thromboembolic Disorders, Jagiellonian University Medical College, 31-202 Krakow, Poland
| | - Aleksandra Karcińska
- Student Research Group at Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (A.K.); (G.H.); (A.d.C.Y.); (J.L.); (A.G.)
| | - Grzegorz Horosin
- Student Research Group at Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (A.K.); (G.H.); (A.d.C.Y.); (J.L.); (A.G.)
| | - Alicia del Carmen Yika
- Student Research Group at Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (A.K.); (G.H.); (A.d.C.Y.); (J.L.); (A.G.)
| | - Julia Lenart
- Student Research Group at Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (A.K.); (G.H.); (A.d.C.Y.); (J.L.); (A.G.)
| | - Anna Górowska
- Student Research Group at Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (A.K.); (G.H.); (A.d.C.Y.); (J.L.); (A.G.)
| | - Sylwia Iwańczyk
- 1st Department of Cardiology, Poznan University of Medical Sciences, 61-848 Poznan, Poland;
| | - Mateusz Podolec
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (M.P.); (A.S.); (J.N.); (J.Z.)
- Center for Innovative Medical Education, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Aleksander Siniarski
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (M.P.); (A.S.); (J.N.); (J.Z.)
| | - Jadwiga Nessler
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (M.P.); (A.S.); (J.N.); (J.Z.)
| | - Jarosław Zalewski
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (M.P.); (A.S.); (J.N.); (J.Z.)
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Moady G, Yelin B, Sweid R, Atar S. C-Reactive Protein Can Predict Outcomes in Patients With Takotsubo Syndrome. INTERNATIONAL JOURNAL OF HEART FAILURE 2024; 6:28-33. [PMID: 38303919 PMCID: PMC10827700 DOI: 10.36628/ijhf.2023.0033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 09/10/2023] [Accepted: 09/26/2023] [Indexed: 02/03/2024]
Abstract
Background and Objectives Takotsubo syndrome (TTS) is a form of reversible cardiomyopathy often preceded by mental or physical stressors and predominantly affects elderly women. Several cardiac and inflammatory biomarkers are involved in the pathogenesis of the disease. We aimed to investigate the correlation of C-reactive protein (CRP) level with left ventricular ejection fraction (LVEF) and clinical outcomes in patients with TTS. Methods The study included patients with discharge-diagnosis of Takotsubo through 2017-2022 from the cardiology department. Demographic, laboratory, echocardiographic, and clinical outcomes were retrospectively obtained. We investigated the relation between CRP and LVEF, length of stay (LOS), in-hospital complications, and recurrence. Results A total of 86 patients (93% female, mean age 68.8±12.3 years) were included in the study. The median CRP level was 17.4 (interquartile range [IQR], 6.1-40.1) mg/L, and the mean LVEF was 41.5%, (IQR, 38-50%). Complications occurred in 24 (27.9%) of the patients, and the median LOS was 3 (IQR, 3-5) days. The level of CRP was associated with lower LVEF (r=-0.39, p<0.001), longer hospital stay (r=0.25, p=0.021), and recurrence. There was no correlation between CRP and in-hospital complications. In multivariate logistic regression, poor LVEF was associated with TTS recurrence (odds ratio, 1.22; 95% confidence interval, 1.08-1.37; p=0.001). Using linear regression, only CRP was correlated with longer LOS and lower LVEF (p<0.001). Conclusions Among patients hospitalized with TTS, CRP level was associated with poor LVEF and prolonged hospital stay but not with in-hospital complications. Poor LVEF was also associated with TTS recurrence.
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Affiliation(s)
- Gassan Moady
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - BateL Yelin
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Rania Sweid
- Biostatistics Unit, Galilee Medical Center, Nahariya, Israel
| | - Shaul Atar
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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Pimentel-Esparza JA, Rios-Gomez M, Cervantes-Nieto JA, Fuentes Mendoza JA. Massive Pulmonary Embolism Related to a Patient With Heart Failure Secondary to Stress Cardiomyopathy: A Case Report. Cureus 2024; 16:e52985. [PMID: 38406044 PMCID: PMC10894014 DOI: 10.7759/cureus.52985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Venous thromboembolism (VTE) is a common disease, which includes deep venous thrombosis (DVT) and pulmonary embolism (PE). It is the third most common cardiovascular disorder, affecting predominantly the male elderly population. Stress cardiomyopathy (SC) is a transitorily cardiovascular condition produced after an emotional or physical trigger, and it features signs and symptoms of acute coronary syndrome. Its pathophysiological mechanisms remain unclear, and SC has also been related to critical complications such as heart failure, arrhythmias, left ventricular outflow obstruction, and thromboembolic events. This case report highlights the association of PE and SC that might play a pathophysiological role.
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Affiliation(s)
| | - Mariana Rios-Gomez
- Department of Internal Medicine, Petróleos Mexicanos (PEMEX) Regional Hospital Salamanca, Salamanca, MEX
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Kumar HN, Jeevanandham S, Ganesh MS, Sabana MA, Manivasakam P. Emerging Strategies and Effective Prevention Measures for Investigating the Association Between Stroke and Sudden Cardiac Fatality. Curr Cardiol Rev 2024; 20:35-44. [PMID: 38310557 DOI: 10.2174/011573403x259676231222053709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/19/2023] [Accepted: 11/17/2023] [Indexed: 02/06/2024] Open
Abstract
Stroke-related cardiac death is a significant concern for patients with stroke and their healthcare providers. It is a complex and multifaceted condition that requires careful management of both modifiable and non-modifiable risk factors. This review provides an overview of the pathophysiology, risk factors, and prevention strategies for stroke-related cardiac death. The review highlights the importance of identifying and managing modifiable risk factors such as hypertension, diabetes, and lifestyle factors, as well as non-modifiable risk factors such as age and genetics. Additionally, the review explores emerging strategies for prevention, including the use of wearable devices and genetic testing to identify patients at risk, stem cell therapy and gene therapy for cardiac dysfunction, and precision medicine for personalized treatment plans. Despite some limitations to this review, it provides valuable insights into the current understanding of stroke-related cardiac death and identifies important areas for future research. Ultimately, the implementation of evidence-based prevention strategies and personalized treatment plans has the potential to improve outcomes for patients with stroke and reduce the burden of stroke-related cardiac death in the population.
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Affiliation(s)
- H Nithesh Kumar
- Pharmacy Practice, JKKN College of Pharmacy, Namakkal, India
| | - S Jeevanandham
- Pharmacy Practice, JKKN College of Pharmacy, Namakkal, India
| | | | - M Ashmi Sabana
- Pharmacy Practice, JKKN College of Pharmacy, Namakkal, India
| | - P Manivasakam
- Pharmacy Practice, JKKN College of Pharmacy, Namakkal, India
- Department of Pharmaceutics, Vellalar College of Pharmacy, Erode, India
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Wang T, Xiong T, Yang Y, Chen X, Ma Z, Zuo B, Ning D, Zhou B, Song R, Liu X, Wang D. Estradiol-mediated small GTP-binding protein GDP dissociation stimulator induction contributes to sex differences in resilience to ferroptosis in takotsubo syndrome. Redox Biol 2023; 68:102961. [PMID: 38007983 PMCID: PMC10719533 DOI: 10.1016/j.redox.2023.102961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/01/2023] [Accepted: 11/10/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Declining beneficial cardiovascular actions of estradiol (E2) have been associated with disproportionate susceptibility to takotsubo syndrome (TTS) in postmenopausal women. However, the underlying mechanisms between E2 and this marked disproportion remain unclear. SmgGDS (small GTP-binding protein GDP dissociation stimulator), as a key modulator of cardiovascular disease, plays protective roles in reducing oxidative stress and exerts pleiotropic effects of statins. Whether SmgGDS levels are influenced by E2 status and the effect of SmgGDS on sex differences in TTS are poorly understood. METHODS Clinical data were reviewed from TTS inpatients. Echocardiography, immunofluorescence, and immunohistochemistry were performed together with expression analysis to uncover phenotypic and mechanism changes in sex differences in TTS-like wild-type (WT) and SmgGDS± mice. HL-1 cardiomyocytes were used to further examine and validate molecular mechanisms. RESULTS In 14 TTS inpatients, TTS had a higher incidence in postmenopausal women as compared to premenopausal women and men. In murine TTS, female WT mice exhibited higher cardiac SmgGDS levels than male WT mice. Ovariectomy reduced SmgGDS expression in female WT mice similar to that observed in male mice, whereas E2 replacement in these ovariectomized (OVX) female mice reversed this effect. The physiological importance of this sex-specific E2-mediated SmgGDS response is underscored by the disparity in cardiac adaptation to isoproterenol (ISO) stimulation between both sexes of WT mice. E2-mediated SmgGDS induction conferred female protection against TTS-like acute cardiac injury involving ferritinophagy-mediated ferroptosis. No such cardioprotection was observed in male WT mice and OVX female. A causal role for SmgGDS in this sex-specific cardioprotective adaptation was indicated, inasmuch as SmgGDS deficiency abolished E2-modulated cardioprotection against ferritinophagy and aggravates TTS progression in both sexes. Consistently, knockdown of SmgGDS in HL-1 cardiomyocytes exacerbated ferroptosis in a ferritinophagy-dependent manner and abrogated the protective role of E2 against ferritinophagy. Mechanistically, our findings revealed that SmgGDS regulated E2-dependent cardioprotective effects via AMPK/mTOR signaling pathway. SmgGDS deficiency abolished E2-conferred protection against ferritinophagy through activating AMPK/mTOR pathway, while treatment with recombinant SmgGDS in HL-1 cells significantly mitigated this pathway-associated ferritinophagy activity. CONCLUSIONS These results demonstrate that SmgGDS is a central mediator of E2-conferred female cardioprotection against ferritinophagy-mediated ferroptosis in TTS.
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Affiliation(s)
- Ti Wang
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People's Hospital), Taizhou, Jiangsu, China; Cardiology Division, Emory University School of Medicine, Atlanta, GA, USA
| | - Ting Xiong
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuxue Yang
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People's Hospital), Taizhou, Jiangsu, China
| | - Xiwei Chen
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People's Hospital), Taizhou, Jiangsu, China
| | - Ziwei Ma
- Clinical Medical College, Dalian Medical University, Dalian, Liaoning, China
| | - Bangyun Zuo
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People's Hospital), Taizhou, Jiangsu, China
| | - Dong Ning
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Beibei Zhou
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People's Hospital), Taizhou, Jiangsu, China
| | - Ruilong Song
- College of Veterinary Medicine, Yangzhou University, Yangzhou, Jiangsu, China
| | - Xuesong Liu
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
| | - Daxin Wang
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People's Hospital), Taizhou, Jiangsu, China.
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Hu JR, Abdullah A, Nanna MG, Soufer R. The Brain-Heart Axis: Neuroinflammatory Interactions in Cardiovascular Disease. Curr Cardiol Rep 2023; 25:1745-1758. [PMID: 37994952 PMCID: PMC10908342 DOI: 10.1007/s11886-023-01990-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE OF REVIEW The role of neuroimmune modulation and inflammation in cardiovascular disease has been historically underappreciated. Physiological connections between the heart and brain, termed the heart-brain axis (HBA), are bidirectional, occur through a complex network of autonomic nerves/hormones and cytokines, and play important roles in common disorders. RECENT FINDINGS At the molecular level, advances in the past two decades reveal complex crosstalk mediated by the sympathetic and parasympathetic nervous systems, the renin-angiotensin aldosterone and hypothalamus-pituitary axes, microRNA, and cytokines. Afferent pathways amplify proinflammatory signals via the hypothalamus and brainstem to the periphery, promoting neurogenic inflammation. At the organ level, while stress-mediated cardiomyopathy is the prototypical disorder of the HBA, cardiac dysfunction can result from a myriad of neurologic insults including stroke and spinal injury. Atrial fibrillation is not necessarily a causative factor for cardioembolic stroke, but a manifestation of an abnormal atrial substrate, which can lead to the development of stroke independent of AF. Central and peripheral neurogenic proinflammatory factors have major roles in the HBA, manifesting as complex bi-directional relationships in common conditions such as stroke, arrhythmia, and cardiomyopathy.
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Affiliation(s)
- Jiun-Ruey Hu
- Section of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Ave, New Haven, CT, 06519, USA
| | - Ahmed Abdullah
- Section of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Ave, New Haven, CT, 06519, USA
| | - Michael G Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Ave, New Haven, CT, 06519, USA
| | - Robert Soufer
- Section of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Ave, New Haven, CT, 06519, USA.
- VA Connecticut Healthcare System, 950 Campbell Ave, -111B, West Haven, CT, 06516, USA.
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Nistor IR, Gherasim L. From Neurocardiology to Stroke-Heart Syndrome. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2023; 61:177-185. [PMID: 37540842 DOI: 10.2478/rjim-2023-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Indexed: 08/06/2023]
Abstract
The Stroke-Heart syndrome is a major chapter in neurocardiology. Both brain-heart and stroke-heart correlations are based on neurophysiological studies that define and describe the relation between the central autonomic system and cardiac function and it will be presented in this narrative review. The Stroke-Heart syndrome groups the entire spectrum of cardiac changes - clinical, ECG, echocardiographic, biological, morphological - that occur in the first 30 days from the onset of stroke, especially in the first days. Their presence significantly marks the evolution and prognosis of stroke. The damage resulted from hypothalamus-pituitary-adrenal axis activation and high catecholamine release (adrenergic storm) targets mainly the myocyte and the microcirculation.The Takotsubo syndrome and Stunned myocardium are distinct forms of neurogenic myocardial ischemia - with changes in ECG, parietal motility, and biological markers - usually reversible although evolution towards cardiac dysfunction is also possible. The concept of Stroke-Heart syndrome and the brain-heart correlation brought new scientific information regarding stress cardiomyopathy or neurogenic myocardial injury.
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Affiliation(s)
- Ileana Raluca Nistor
- 1Neurology Clinic, "Carol Davila" University of Medicine and Farmacy, Bucharest, Romania
| | - Leonida Gherasim
- 2Cardiology Clinic, "Carol Davila" University of Medicine and Farmacy, Bucharest, Romania
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Pogran E, Zweiker D, Gargiulo L, El‐Razek AA, Lechner I, Vosko I, Rechberger S, Bugger H, Christ G, Bonderman D, Kunschitz E, Zirlik A, Bauer A, Metzler B, Lambert T, Steinwender C, Huber K. Takotsubo syndrome before and during the COVID-19 pandemic in Austria: a retrospective cohort study (TOSCA-19). ESC Heart Fail 2023; 10:3667-3676. [PMID: 37803874 PMCID: PMC10682936 DOI: 10.1002/ehf2.14536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/05/2023] [Accepted: 09/08/2023] [Indexed: 10/08/2023] Open
Abstract
AIMS This study aims to investigate the prevalence of Takotsubo syndrome (TTS) as a percentage of the total number of acute coronary syndrome (ACS), including non-STE-elevation myocardial infarction and ST-elevation myocardial infarction, as well as the short-term outcome of TTS patients before and during the COVID-19 pandemic. METHODS AND RESULTS We compared patients from two different periods: (i) Period 1 (before the COVID-19 pandemic): 1 March to 30 December 2019, and (ii) Period 2 (during the COVID-19 pandemic): 1 March to 30 December 2020. The retrospective database was created from the archives of the participating hospitals or electronic hospital systems by trained medical personnel. The subjects' medical history, cardiovascular risk factors, laboratory values, echocardiography findings, and an in-hospital outcome were variables of interest. Furthermore, propensity score matching analysis was performed to evaluate the short-term prognosis in TTS and ACS patients. Altogether six Austrian centres-(i) 3rd Medical Department of Cardiology and Intensive Care Medicine, Clinic Ottakring, Vienna, Austria; (ii) 5th Medical Department of Cardiology, Clinic Favoriten, Vienna, Austria; (iii) 2nd Medical Department, Hanusch Hospital, Vienna, Austria; (iv) University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria; (v) Department of Cardiology, University Hospital Graz, Graz, Austria; (vi) Department of Cardiology and Intensive Medicine, Kepler University Clinic, Linz, Austria-participated in the study. During period 1, 87 (3.5%) patients out of 2482 ACS patients had TTS in all participating centres. During period 2, 71 (2.7%) patients out of 2572 ACS patients had TTS in all participating centres. Accordingly, the prevalence of TTS remained stable irrespective of potential psychologic stress during the COVID pandemic. Furthermore, the baseline characteristics of TTS patients did not change during the COVID-19 pandemic. The prevalence of in-hospital complications [cardiogenic shock (4.6% vs. 4.3%, P = 0.925), ventricle thrombus (1.1% vs. 1.4%, P = 0.885) and in-hospital bleeding (3.4% vs. 1.4%, P = 0.417)] remained stable. The all-cause in-hospital mortality of TTS patients did not change during the COVID-19 pandemic [χ2 (2) = 0.058, P = 0.810]. Moreover, a propensity score matching analysis of all-cause in-hospital mortality between matched TTS and ACS patients showed higher in-hospital mortality in ACS patients during COVID-19 pandemic (P = 0.043). CONCLUSIONS Despite the well-known increased psychologic stress during the COVID-19 pandemic, the prevalence of TTS during the COVID-19 pandemic and the short-term clinical outcome in Austria remained unimpacted.
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Affiliation(s)
- Edita Pogran
- 3rd Medical Department of Cardiology and Intensive Care MedicineClinic Ottakring (former Wilhelminenhospital)ViennaAustria
- Doctoral Programme Meduni ViennaMedical University of ViennaViennaAustria
| | - David Zweiker
- 3rd Medical Department of Cardiology and Intensive Care MedicineClinic Ottakring (former Wilhelminenhospital)ViennaAustria
| | - Laura Gargiulo
- School of MedicineSigmund Freud Private UniversityViennaAustria
| | | | - Ivan Lechner
- University Clinic for Internal Medicine III‐Cardiology and AngiologyInnsbruckAustria
| | - Ivan Vosko
- Department of CardiologyUniversity Hospital GrazGrazAustria
| | - Stefan Rechberger
- Department of Cardiology and Intensive Care MedicineKepler University Hospital LinzLinzAustria
| | - Heiko Bugger
- Department of CardiologyUniversity Hospital GrazGrazAustria
| | - Günter Christ
- 5th Medical Department of CardiologyClinic FavoritenViennaAustria
| | - Diana Bonderman
- 5th Medical Department of CardiologyClinic FavoritenViennaAustria
| | | | - Andreas Zirlik
- Department of CardiologyUniversity Hospital GrazGrazAustria
| | - Axel Bauer
- University Clinic for Internal Medicine III‐Cardiology and AngiologyInnsbruckAustria
| | - Bernhard Metzler
- University Clinic for Internal Medicine III‐Cardiology and AngiologyInnsbruckAustria
| | - Thomas Lambert
- Department of Cardiology and Intensive Care MedicineKepler University Hospital LinzLinzAustria
| | - Clemens Steinwender
- Department of Cardiology and Intensive Care MedicineKepler University Hospital LinzLinzAustria
| | - Kurt Huber
- 3rd Medical Department of Cardiology and Intensive Care MedicineClinic Ottakring (former Wilhelminenhospital)ViennaAustria
- School of MedicineSigmund Freud Private UniversityViennaAustria
- Ludwig Boltzmann Institute for Interventional Cardiology and RhythmologyMedical University of ViennaViennaAustria
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Schweiger V, Gilhofer T, Fang R, Candreva A, Seifert B, Di Vece D, Wuerdinger M, Koleva I, Rajman K, Cieslik M, Gotschy A, Michel J, Stehli J, Niederseer D, Ryberg L, Ghadri J, Ruschitzka F, Stähli B, Cammann VL, Templin C. Coronary microvascular dysfunction in Takotsubo syndrome: an analysis using angiography-derived index of microcirculatory resistance. Clin Res Cardiol 2023:10.1007/s00392-023-02329-7. [PMID: 37985475 DOI: 10.1007/s00392-023-02329-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/18/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Coronary microvascular dysfunction (CMD) has been proposed as a crucial factor in the pathophysiology of Takotsubo syndrome (TTS). The angiography-derived index of microcirculatory resistance (caIMR) offers an alternative to conventional hyperemic wire-based IMR to assess CMD. We aimed to evaluate CMD's prevalence, transience, and impact on in-hospital outcomes in TTS. METHODS All three coronary arteries of 96 patients with TTS were assessed for their coronary angiography derived Index of microcirculatory Resistance (caIMR) and compared to non-obstructed vessels of matched patients with ST-elevation myocardial infarction. Further, the association between caIMR and the TTS-specific combined in-hospital endpoint of death, cardiac arrest, ventricular arrhythmogenic events and cardiogenic shock was investigated. RESULTS Elevated IMR was present in all TTS patients, with significantly elevated caIMR values in all coronary arteries compared to controls. CaIMR did not differ between apical and midventricular TTS types. CaIMR normalized in TTS patients with follow-up angiographies performed at a median of 28 months (median caIMR at event vs follow-up: LAD 34.8 [29.9-41.1] vs 20.3 [16.0-25.3], p < 0.001; LCX: 38.7 [32.9-50.1] vs 23.7 [19.4-30.5], p < 0.001; RCA: 31.7 [25.0-39.1] vs 19.6 [17.1-24.0], p < 0.001). The extent of caIMR elevation significantly correlated with the combined in-hospital endpoint (p = 0.036). CONCLUSION TTS patients had evidence of elevated caIMR in at least one coronary artery with a trend towards higher LAD caIMR in apical type TTS and normalization after recovery. Furthermore, extent of caIMR elevation was associated with increased risk of in-hospital MACE of TTS patients.
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Affiliation(s)
- Victor Schweiger
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Thomas Gilhofer
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Rick Fang
- Suzhou Rainmed Medical Technology Co., Ltd, Building 31, Northeast District, Nano City, No. 99 Jinji Lake Avenue, Suzhou Industrial Park, Suzhou, China
| | - Alessandro Candreva
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Burkhardt Seifert
- Division of Biostatistics, Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Davide Di Vece
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Michael Wuerdinger
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Iva Koleva
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Katja Rajman
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Maciej Cieslik
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Alexander Gotschy
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Jonathan Michel
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Julia Stehli
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - David Niederseer
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Linn Ryberg
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Jelena Ghadri
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Barbara Stähli
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Victoria Lucia Cammann
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
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Delcuratolo E, Palazzuoli A, Coppi F, Mattioli AV, Severino P, Tramonte F, Fedele F. Risk Factors and Cellular Differences in Heart Failure: The Key Role of Sex Hormones. Biomedicines 2023; 11:3052. [PMID: 38002052 PMCID: PMC10669789 DOI: 10.3390/biomedicines11113052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Patients with heart failure are conventionally stratified into phenotypic groups based on their ejection fraction. The aim of this stratification is to improve disease management with a more targeted therapeutic approach. A further subdivision based on patient gender is justified. It is recognized that women are underrepresented in randomized controlled clinical trials, resulting in limited clinical and molecular differentiation between males and females. However, many observational studies show that the onset, development, and clinical course of the disease may substantially differ between the two sexes. According to the emerging concept of precision medicine, investigators should further explore the mechanisms responsible for the onset of heart failure due to sex differences. Indeed, the synergistic or opposing effects of sex hormones on the cardiovascular system and underlying heart failure mechanisms have not yet been clarified. Sex hormones, risk factors impact, and cardiovascular adaptations may be relevant for a better understanding of the intrinsic pathophysiological mechanisms in the two sexes. Despite the differences, treatment for HF is similar across the whole population, regardless of sex and gender. In our review, we describe the main differences in terms of cardiovascular dysfunction, risk factors, and cellular signaling modifications related to the hormonal pattern.
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Affiliation(s)
- Elvira Delcuratolo
- Specialization School of Cardiology, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy;
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Le Scotte Hospital, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy;
| | - Francesca Coppi
- National Institute for Cardiovascular Research, Via Irnerio 48, 40126 Bologna, Italy; (F.C.); (A.V.M.); (F.F.)
| | - Anna Vittoria Mattioli
- National Institute for Cardiovascular Research, Via Irnerio 48, 40126 Bologna, Italy; (F.C.); (A.V.M.); (F.F.)
| | - Paolo Severino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy;
| | - Francesco Tramonte
- Cardiovascular Diseases Unit, Le Scotte Hospital, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy;
| | - Francesco Fedele
- National Institute for Cardiovascular Research, Via Irnerio 48, 40126 Bologna, Italy; (F.C.); (A.V.M.); (F.F.)
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Rosso M, Ramaswamy S, Kvantaliani N, Mulatu Y, Little JN, Marczak I, Brahmaroutu A, Deo R, Lewey J, Messé SR, Cucchiara BL, Levine SR, Kasner SE. Stroke-Heart Syndrome: Does Sex Matter? J Am Heart Assoc 2023; 12:e029799. [PMID: 37850436 PMCID: PMC10727394 DOI: 10.1161/jaha.123.029799] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/09/2023] [Indexed: 10/19/2023]
Abstract
Background Cardiovascular complications after acute ischemic stroke (AIS) can be related to chronic/comorbid cardiac conditions or acute disruption of the brain-heart autonomic axis (stroke-heart syndrome). Women are known to be more vulnerable to certain stress-induced cardiac complications, such as Takotsubo cardiomyopathy. We investigated sex differences in cardiac troponin (cTn) elevation, cardiac events, and outcomes after AIS. Methods and Results We retrospectively analyzed consecutive patients with AIS from 5 stroke centers. Patients with AIS with elevated baseline cTn and at least 2 cTn measurements were included, while patients with acute comorbid conditions that could impact cTn levels were excluded. Poststroke acute myocardial injury was defined as the presence of a dynamic cTn pattern (rise/fall >20% in serial measurements) in the absence of acute atherosclerotic coronary disease (type 1 myocardial infarction) or cardiac death (type 3 myocardial infarction). From a total cohort of 3789 patients with AIS, 300 patients were included in the study: 160 were women (53%). Women were older, had a lower burden of cardiovascular risk factors, and more frequently had cardioembolic stroke and right insula involvement (P values all <0.05). In multivariate analysis, women were more likely to have a dynamic cTn pattern (adjusted odds ratio, 2.1 [95% CI, 1.2-3.6]) and develop poststroke acute myocardial injury (adjusted odds ratio, 2.1 [95% CI, 1.1-3.8]). Patients with poststroke acute myocardial injury had higher 7-day mortality (adjusted odds ratio, 5.5 [95% CI, 1.2-24.4]). Conclusions In patients with AIS with elevated cTn at baseline, women are twice as likely to develop poststroke acute myocardial injury, and this is associated with higher risk of short-term mortality. Translational studies are needed to clarify mechanisms underlying sex differences in cardiac events and mortality in AIS.
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Affiliation(s)
- Michela Rosso
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPA
| | - Srinath Ramaswamy
- Department of NeurologySUNY Downstate Health Sciences UniversityBrooklynNY
| | | | - Yohannes Mulatu
- Department of NeurologySUNY Downstate Health Sciences UniversityBrooklynNY
| | | | - Izabela Marczak
- Department of NeurologySUNY Downstate Health Sciences UniversityBrooklynNY
| | | | - Rajat Deo
- Division of Cardiology, Department of MedicineUniversity of PennsylvaniaPhiladelphiaPA
| | - Jennifer Lewey
- Division of Cardiology, Department of MedicineUniversity of PennsylvaniaPhiladelphiaPA
| | - Steven R. Messé
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPA
| | | | - Steven R. Levine
- Department of NeurologySUNY Downstate Health Sciences UniversityBrooklynNY
| | - Scott E. Kasner
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPA
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Amadio P, Porro B, Cavalca V, Zarà M, Eligini S, Sandrini L, Werba JP, Cosentino N, Olivares P, Galotta A, Bonomi A, Tremoli E, Trabattoni D, Barbieri SS. Hemostatic system in Takotsubo patients at long-term follow-up: A hidden activation? Int J Cardiol 2023; 390:131229. [PMID: 37527756 DOI: 10.1016/j.ijcard.2023.131229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Takotsubo cardiomyopathy (TTS) has long been considered a benign condition, despite recurrent events and long-term adverse outcomes are often reported. Endothelial damage, blood hyperviscosity, and platelet activation described in acute phase persist in long-term follow-up; however, TTS pathophysiology is still not fully understood. Here, we explored the hemostatic system at a median of 3.1 years after TTS to uncover additional long-lasting changes in these patients. METHODS We assessed hemostatic parameters in women with TTS (n = 23) or coronary artery disease (CAD; n = 31) and in control women (n = 26) age-matched, by thromboelastographic analysis, prothrombin time (PT) and partial thromboplastin time (aPTT) coagulation assays and microparticle exposing Tissue Factor (MP-TF). Functional fibrinogen and fibrin polymerization were analyzed by Clauss method and spectrophotometry, respectively. Platelet reactivity was evaluated by light transmission aggregometry, whereas plasminogen activator inhibitor-1 (PAI-1) and brain-derived neurotrophic factor (BDNF) were measured by ELISA kit. RESULTS Compared with control subjects, TTS patients exhibit an accelerated clot formation, higher percentage of fibrin polymerization and higher PAI-1 levels. Compared with CAD, TTS patients showed sustained residual platelet activation but decreased functional fibrinogen, fibrin polymerization and MP-TF levels, prolonged aPTT and a marked BDNF increase. CONCLUSIONS The long-term activation of hemostatic system observed in TTS patients compared to control subjects suggests a persistent humoral abnormality that may be related to the propensity for TTS recurrence. The higher residual platelet activity observed in TTS than in CAD patients invites investigation on TTS-tailored antiplatelet therapy potentially needed to prevent TTS adverse outcomes.
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Affiliation(s)
| | | | | | - Marta Zarà
- Centro Cardiologico Monzino I.R.C.C.S., Milan, Italy
| | - Sonia Eligini
- Centro Cardiologico Monzino I.R.C.C.S., Milan, Italy
| | | | | | | | | | | | - Alice Bonomi
- Centro Cardiologico Monzino I.R.C.C.S., Milan, Italy
| | - Elena Tremoli
- Maria Cecilia Hospital, GVM Care & Research, 48033, Cotignola, Ravenna, Italy
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Su E, Dutko A, Ginsburg S, Lasa JJ, Nakagawa TA. Death and Ultrasound Evidence of the Akinetic Heart in Pediatric Cardiac Arrest. Pediatr Crit Care Med 2023; 24:e568-e572. [PMID: 37318261 DOI: 10.1097/pcc.0000000000003307] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Point-of-care ultrasound (POCUS) is an expanding noninvasive diagnostic modality used for the management of patients in multiple intensive care and pediatric specialties. POCUS is used to assess cardiac activity and pathology, pulmonary disease, intravascular volume status, intra-abdominal processes, procedural guidance including vascular access, lumbar puncture, thoracentesis, paracentesis, and pericardiocentesis. POCUS has also been used to determine anterograde flow following circulatory arrest when organ donation after circulatory death is being considered. Published guidelines exist from multiple medical societies including the recent guidelines for the use of POCUS in neonatology for diagnostic and procedural purposes.
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Affiliation(s)
- Erik Su
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Amy Dutko
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Sarah Ginsburg
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Texas Southwestern Medical School, Dallas, TX
| | - Javier J Lasa
- Divisions of Pediatric Cardiology and Pediatric Critical Care Medicine, Department of Pediatrics, University of Texas Southwestern Medical School, Dallas, TX
| | - Thomas A Nakagawa
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Jacksonville, FL
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Vukomanovic D, Hajek K, Unzek S, Gopalan R, Mookadam F. The stress clot: Mid-cavitary variant takotsubo cardiomyopathy with left ventricular thrombus. Echocardiography 2023; 40:1280-1284. [PMID: 37725057 DOI: 10.1111/echo.15692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/15/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023] Open
Abstract
Pregnancy and the post-partum period are known hypercoagulable states. Mid-cavitary variant Takotsubo cardiomyopathy (TCM) is uncommon and seen in only about 14% of all Takotsubo cases. Left ventricular thrombus (LVT) in the setting of mid-cavitary TCM is extremely rare, occurring in approximately 1% of cases. We describe a case of a young female, 1-week post-partum, with an acute LVT in the setting of mid-ventricular TCM, and we discuss the striking images and clinical management of this uncommon presentation.
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Affiliation(s)
- Damir Vukomanovic
- Department of Cardiology, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Kyle Hajek
- Department of Cardiology, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Samuel Unzek
- Department of Cardiology, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Radha Gopalan
- Department of Cardiology, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Farouk Mookadam
- Department of Cardiology, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
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Belmonte M, Gallinoro E, Bermpeis K, Bertolone DT, Paolisso P, Viscusi MM, Botti G, Bartunek J, Barbato E, Vanderheyden M. Comprehensive invasive evaluation of coronary microcirculation in patients with Takotsubo syndrome. Atherosclerosis 2023; 385:117332. [PMID: 37866008 DOI: 10.1016/j.atherosclerosis.2023.117332] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND AND AIMS The etiology and pathophysiology of Takotsubo syndrome (TTS) remain a matter of debate. In murine models of coronary microvascular dysfunction (CMD), abnormalities in myocardial perfusion led to the development of TTS. Importantly, TTS was reversible when normal perfusion was restored. However, in clinical practice, the assessment of coronary microcirculation in patients with TTS has primarily relied on non-invasive or indirect, angiography-derived methods. METHODS AND RESULTS For the first time, we performed invasive microcirculatory assessment, by both validated techniques currently available in the catheterization laboratory, namely intracoronary bolus and continuous thermodilution, in patients with TTS, upon hospital admission and at short term follow-up. Our findings demonstrate that CMD was consistently present in all patients upon hospital admission, as assessed by both techniques. At a median follow-up of 3 months, after the recovery of left ventricular ejection fraction, two third of patients no longer exhibited CMD. CONCLUSIONS These findings support the hypothesis that an acute and transient worsening in coronary microvascular function plays a pivotal role in the pathophysiology of TTS.
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Affiliation(s)
- Marta Belmonte
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Dept. of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | | | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Dept. of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Dept. of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Michele Mattia Viscusi
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Dept. of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Giulia Botti
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Italy
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Manolis AA, Manolis TA, Manolis AS. Neurohumoral Activation in Heart Failure. Int J Mol Sci 2023; 24:15472. [PMID: 37895150 PMCID: PMC10607846 DOI: 10.3390/ijms242015472] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/16/2023] [Accepted: 10/21/2023] [Indexed: 10/29/2023] Open
Abstract
In patients with heart failure (HF), the neuroendocrine systems of the sympathetic nervous system (SNS), the renin-angiotensin-aldosterone system (RAAS) and the arginine vasopressin (AVP) system, are activated to various degrees producing often-observed tachycardia and concomitant increased systemic vascular resistance. Furthermore, sustained neurohormonal activation plays a key role in the progression of HF and may be responsible for the pathogenetic mechanisms leading to the perpetuation of the pathophysiology and worsening of the HF signs and symptoms. There are biomarkers of activation of these neurohormonal pathways, such as the natriuretic peptides, catecholamine levels and neprilysin and various newer ones, which may be employed to better understand the mechanisms of HF drugs and also aid in defining the subgroups of patients who might benefit from specific therapies, irrespective of the degree of left ventricular dysfunction. These therapies are directed against these neurohumoral systems (neurohumoral antagonists) and classically comprise beta blockers, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers and vaptans. Recently, the RAAS blockade has been refined by the introduction of the angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan, which combines the RAAS inhibition and neprilysin blocking, enhancing the actions of natriuretic peptides. All these issues relating to the neurohumoral activation in HF are herein reviewed, and the underlying mechanisms are pictorially illustrated.
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Affiliation(s)
- Antonis A Manolis
- First Department of Cardiology, Evagelismos Hospital, 106 76 Athens, Greece
| | - Theodora A Manolis
- Department of Psychiatry, Aiginiteio University Hospital, 115 28 Athens, Greece
| | - Antonis S Manolis
- First Department of Cardiology, Ippokrateio University Hospital, 115 27 Athens, Greece
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Xu C, Wang G, He J. Precipitating factors in patients with spontaneous coronary artery dissection: Emotional stressors matter. Int J Cardiol 2023; 389:131169. [PMID: 37423568 DOI: 10.1016/j.ijcard.2023.131169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/06/2023] [Indexed: 07/11/2023]
Affiliation(s)
- Can Xu
- The First Affiliated Hospital of University of South China, Department of Cardiology, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, PR China
| | - Gang Wang
- The First Affiliated Hospital of University of South China, Department of Cardiology, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, PR China
| | - Jin He
- The First Affiliated Hospital of University of South China, Department of Function, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, PR China.
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47
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Mills RM. What Becomes of the Brokenhearted? Am J Cardiol 2023; 205:500-501. [PMID: 37666728 DOI: 10.1016/j.amjcard.2023.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 09/06/2023]
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Liu Y, Chen Q, Yang JZ, Li XW, Chen LJ, Zhang KK, Liu JL, Li JH, Hsu C, Chen L, Zeng JH, Wang Q, Zhao D, Xu JT. Multi-Omics Analysis Reveals the Role of Sigma-1 Receptor in a Takotsubo-like Cardiomyopathy Model. Biomedicines 2023; 11:2766. [PMID: 37893138 PMCID: PMC10604683 DOI: 10.3390/biomedicines11102766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Takotsubo syndrome (TTS) is a stress-induced cardiomyopathy that presents with sudden onset of chest pain and dyspneic and cardiac dysfunction as a result of extreme physical or emotional stress. The sigma-1 receptor (Sigmar1) is a ligand-dependent molecular chaperone that is postulated to be involved in various processes related to cardiovascular disease. However, the role of Sigmar1 in TTS remains unresolved. In this study, we established a mouse model of TTS using wild-type and Sigmar1 knockout mice to investigate the involvement of Sigmar1 in TTS development. Our results revealed that Sigmar1 knockout exacerbated cardiac dysfunction, with a noticeable decrease in ejection fraction (EF) and fractional shortening (FS) compared to the wild-type model. In terms of the gut microbiome, we observed regulation of Firmicutes and Bacteroidetes ratios; suppression of probiotic Lactobacillus growth; and a rise in pathogenic bacterial species, such as Colidextribacter. Metabolomic and transcriptomic analyses further suggested that Sigmar1 plays a role in regulating tryptophan metabolism and several signaling pathways, including MAPK, HIF-1, calcium signaling, and apoptosis pathways, which may be crucial in TTS pathogenesis. These findings offer valuable insight into the function of Sigmar1 in TTS, and this receptor may represent a promising therapeutic target for TTS.
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Affiliation(s)
- Yi Liu
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China (Q.W.)
| | - Qing Chen
- Key Laboratory of Evidence Science, China University of Political Science and Law, Ministry of Education, Beijing 100088, China
- Beijing Municipal Public Security Judicial Appraisal Center, Beijing 100142, China
| | - Jian-Zheng Yang
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China (Q.W.)
| | - Xiu-Wen Li
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China (Q.W.)
| | - Li-Jian Chen
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China (Q.W.)
| | - Kai-Kai Zhang
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China (Q.W.)
| | - Jia-Li Liu
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China (Q.W.)
| | - Jia-Hao Li
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China (Q.W.)
| | - Clare Hsu
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China (Q.W.)
| | - Long Chen
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China (Q.W.)
| | - Jia-Hao Zeng
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China (Q.W.)
| | - Qi Wang
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China (Q.W.)
| | - Dong Zhao
- Key Laboratory of Evidence Science, China University of Political Science and Law, Ministry of Education, Beijing 100088, China
| | - Jing-Tao Xu
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China (Q.W.)
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Alim S, Shah H, Zahera SM, Rahmatova J, Irfan M, Mahmood Z, Zahra SA. An update on Takotsubo syndrome. J Cardiovasc Med (Hagerstown) 2023; 24:691-699. [PMID: 37577868 DOI: 10.2459/jcm.0000000000001528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
ABSTRACT Takotsubo syndrome (TTS) can be described as an acute, transiently occurring form of heart failure. It typically causes systolic dysfunction of the left ventricle (LV). Perhaps what is of most significance is the reversible nature of TTS, with many patients achieving recovery within a few weeks to months. TTS can be referred to by other names, attributed to its various precipitants, as well as the structural manifestations of the syndrome. Physical and emotional stressors have been identified as the most common of causes, hence the terms 'stress cardiomyopathy' and 'broken heart syndrome'. Precipitants can range from psychological, and hormonal, to molecular mechanisms. The symptoms of TTS can coalesce with other conditions and hence give rise to many differential diagnoses. Most patients present with dyspnoea and chest pain. The latter also presents in acute coronary syndrome (ACS); thus, ACS is a common differential diagnosis for TTS. The coronavirus disease 2019 (COVID-19) pandemic saw a drastic increase in mental health concerns which have persisted beyond this period. Further studies into personality disorders and their potential predisposition to COVID-19 and thus TTS would advance our understanding of the neuropsychiatric triggers of TTS. There is also a need for a single sensitive and specific diagnostic test for TTS as its diagnosis relies on the culmination of clinical presentation, echocardiography, cardiac catheterization, and cardiovascular magnetic resonance imaging (CMR).
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Affiliation(s)
- Samina Alim
- St George's, University of London Medical School
| | - Halia Shah
- St George's, University of London Medical School
| | | | | | | | | | - Syeda Anum Zahra
- The Hillingdon Hospital NHS Trust
- Imperial College School of Medicine, UK
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Woodman R, Miller C, Student J, Freeman K, Perl D, Lockette W. Alpha-methyltyrosine reduces the acute cardiovascular and behavioral sequelae in a murine model of traumatic brain injury. J Trauma Acute Care Surg 2023; 95:542-548. [PMID: 37165479 PMCID: PMC10545058 DOI: 10.1097/ta.0000000000004023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/17/2023] [Accepted: 04/10/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Increased catecholamines contribute to heightened cardiovascular reactivity and behavioral deficits after traumatic brain injury (TBI); adrenergic receptor blockade has limited success in reducing adverse sequelae of TBI. Injury-induced increases in the synthesis of catecholamines could contribute to adverse outcomes in TBI. Inhibition of catecholamine synthesis with alpha-methyltyrosine (αMT) could offer a benefit after TBI. METHODS Original research trial in mice randomized to αMT (50 mg·kg -1 ·d -1 ) or vehicle for 1 week after TBI induced by controlled cortical impact. Primary outcomes of cardiovascular reactivity and behavioral deficits were assessed after 1 week. Secondary outcomes included blood brain barrier permeability and quantification of gene transcription whose products determine intraneuronal chloride concentrations, the release of catecholamines, and activation of the sympathetic nervous system. These genes were the alpha-2 adrenergic receptor ("Adra2c"), the sodium-potassium-chloride cotransporter ("Nkcc1"), and the potassium chloride cotransporter ("Kcc2"). We also assessed the effect of TBI and αMT on the neuronal chloride/bicarbonate exchanger ("Ae3"). RESULTS Traumatic brain injury-induced increases in blood pressure and cardiac reactivity were blocked by αMT. Inhibition of catecholamine synthesis decreased blood brain barrier leakage and improved behavioral outcomes after TBI. Traumatic brain injury diminished the transcription of Adra2c and enhanced expression of Nkcc1 while reducing Kcc2 transcription; αMT prevented the induction of the Nkcc1 by TBI without reversing the effects of TBI on Kcc2 expression; αMT also diminished Ae3 transcription. CONCLUSION Traumatic brain injury acutely increases cardiovascular reactivity and induces behavioral deficits in an αMT-sensitive manner, most likely by inducing Nkcc1 gene transcription. Alpha-methyltyrosine may prove salutary in the treatment of TBI by attenuating the enhanced expression of Nkcc1, minimizing blood brain barrier leakage, and diminishing central catecholamine and sympathetic output. We also found an unreported relationship between Kcc2 and the chloride/bicarbonate exchanger, which should be considered in the design of trials planned to manipulate central intraneuronal chloride concentrations following acute brain injury.
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